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PHYSICAL EFFECTS
& T. A. ENNI.S, . .ATIONERS Aljfb PHlXi ,.:;:•', 118 OLIVE FTBEEr.
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Physical effects
OF
COMPRESSED AIR,
AND OF THE
CAUSES OF PATHOLOGICAL SYMPTOMS
PRODUCED ON MAN, BY mCREASED ATMOSPHERIC PRESSURE
EMPLOYED FOR THE SINKING OF PIERS,
IN THE CONSTRUCTION OF THE
iiiiis 11 II m mm
OVER THE
MISSISSIPPI RIVER AT ST. LOUIS, MISSOURI,
BY
A. JAMINET, M. D.
ST. LOUIS, MO.
R. & T. A. BNNIS, STATIONERS AND PRINTERS, 118 OLIVE STREET.
1871.
PREFACE.
Having no pretensions as a writer, I ask tlie indul-
gence of my readers in offering this result of my
thoughts and observations, which I have divided into
twelve chapters, as will be seen hereafter.
The first eleven chapters of this pamphlet were
prepared for publication on the fifteenth of August,
1870. By unforeseen circumstances, however, its ap-
pearance was delayed, but the delay in its publication
has not caused me to alter anything advanced therein.
The facts observed during the sinking of the caisson
for the East abutment pier, and which are contained in
Chapter XII, on the contrary, have confirmed me in my
conclusions, as to the truth of the cause or causes of
the physiological and pathological phenomena observed
on the men working in an over-condensed atmosphere.
A. JAMINET, M. D.
St. Louis, Mo., 15th August, 1871.
CONTENTS.
CHAPTER I.
Page.
Preliminaries 7
CHAPTER n.
Philosophical observations on the influence of compressed au-, and its
physiological effects on man 14
CHAPTER III.
Personal experience by the writer — ^taken sick and paralyzed after coming
out of the caisson — ^his own pathological obseryations, treatment and
recovery 29
CHAPTER IV.
Pathological symptoms observed among the men working in the air-
chambers — the remedies used as curatives and preventives are
insufficient 32
CHAPTER V.
Death of some of the men — Inquests by the Coroner — post mortem
examinations and opinions of some of the physicians present at the
inquests 34:
CHAPTER VI.
Number of cases still increase among the men — ^Deaths at the Piers — the
writer takes charge of the men working in the au'-chambers —
modifications in the duration of time of work per day — Systematic
directions given for remaining in the air-lock 39
CHAPTER VII.
Decrease of fatal cases — Seventy-seven cases of observations and treatment —
recovery — systematic examination of the men working in the air-
chambers — ^prophylactic treatment 43
CHAPTER VIII.
Progress of the work after recommencing at the East Pier — Change in
the atmospheric condition in the air-lock and au'-chambers during the
filling up with concrete — considerable increase of temperature in the
air-lock 90
6
CHAPTER IX.
Frequent examinations of the men during the time of work in the air-
chambers — an almost cessation of cases 93
CHAPTER X.
Analysis of the pathological effects and their causes — effects of compressed
air on man as a laborer in the air-chambers — and on man as a casual
visitor 95
CHAPTER XI.
Opinions based on facts and observations 112
CHAPTER XII.
Sinking of the caisson for the East abutment pier — results affirmative of
the safety of using compressed air for sinking piers in the construction
of bridges iu deep water — and for maritime purposes 119
CHAPTER L— Preliminaeies.
In any great undertaking, and in engineering and
architectural structures, especially on a large scale,
there are difficulties which are only met with as the
work is progressing ; even the projector himself cannot
devise means to overcome those difficulties but when he
meets them.
In the prosecution of a vast engineering, undertaking,
stupendous, even in its conception, as is the con-
struction of a bridge over the Mississippi river, at St.
Louis, Mo., to connect the Illinois shore with the State
of Missouri, great difficulties had to be overcom'e, and
among them the one of which we will speak hereafter.
To Mr. J. B. Eads, of this city, was reserved the
honor to be the foremost who conceived and dared to
undertake such an immense work — work replete with
difficulties to overcome, to project and mature all the
plans, devices and appliances necessary for the execu-
tion, accomplishment and success of such an unprece-
dented undertaking.
The first thing to be done, and which was a severe
test on his engineering skill, was to devise the mechani-
cal means to sink the piers in the river until the rock
shall be reached, so as to insure permanent and solid
foundations for the immense spans which are to rest on
the piers, the bridge being an arched bridge, (not a
suspension one,) but composed of three spans or arches,
constructed entirely of steel.
It was found necessary by the projector, to build
four piers to support the three spans of five hun-
dred and twelve feet each ; one pier on the western
shore, and three piers in the Mississippi river ; said
piers to be built on caissons made of very thick
8
iron, with an air-Ghamter underneath^ being nine feet
high, inside, and of the same area of the piers, which
for 'the west pier in the river is 2,600 feet, for the east
pier 3,600 feet, and for the east abutment pier 4,800
feet. Each caisson divided into three compartments by
longitudinal timber partitions to support the deck or
ceiling of the caissons, and at the same time the masonry
work, which was to be built ox^er the air-chainhers during
the progress of the sinking of the caissons.
The caissons reaching the bed of the river, the
water to be excluded completely from the air-chamher^
under each pier, by means of air-pumps forcing com-
pressed air into the air-chamber a, to enable men to work
at the excavating and removal of the sand, eighty feet
deep, to reach the roclc at the place lohere the piers had,
to he sunlc ; the excavating of the sand and its removal
from the bed of the river to be made by means of sand-
pumps until the caissons and piers built over them will
rest upon the rock.
The working men in order to reach the air-chamber
or interior of the caissons under the piers had to go
down by circular stairs in a shaft, in the centre of the
piers, the stairs leading to the bottom of which were the
air-locTc or intermedtate chaiiiher and the air-chambers,
are situated.
The air-lock is a cylinder, made of very thick iron,
six feet in diameter and six feet high, and having two
doors large enough to admit easily the passage of a
man ; one door on the north side of the shaft to go from
the shaft into the air-lock, and another door on the east
side of the air-lock to go from the air-lock into the air-
chamhers. The lirst door closing inside the air-lock when
the compressed air is admitted b}^ opening a valve to
e(]iualize the pressure in the air-lock with the air-
chambers, and to allow the door between the air-lock
and tlie air-chambers to open when the pressure is
equalized in both.
9
The door between the air-lock and the air-cftambers
closing inside the air-chambers, so that the compressed
air, forced by the air-pumps into the air-chambers, keep
the door perfectly closed, while the compressed air is
left to escape by another valve in the air-lock, and
which the men have to open, after closing the door from
the air-chambers to the air-lock, when leaving their
work, and return to the normal atmosphere.
From the project to the subsequent commencement
of the work, and its successful continuance without
interruption, we know the result. The work progressed
so far that the east pier, with its caisson, was sunk,
and the rock was reached on the 28th of February,
1870.
To perform such a work at the depth of ninety -live
feet below the surface of the river — which depth
increased in the east pier to one hundred and ten feet
live inches on April 12th, by the rise of water, and
this, without any interruption of the work — was more
than was anticipated.
Once the rock reached and the caissons with the piers
built over them and resting on the rock, and all the
sand in the air-chambers or caissons removed, the
filling of the caissons with concrete had to be done to
let the piers rest on the rook on solid masonry, to insure
permanent solidity and success of the work.
Of the sinking of the two first piers, and filling up of
the air-chambers with concrete, the result surpassed all
expectations of its projector. It was only when,
arrived at the bed of the river, and under the water,
which had to be excluded entirely from tTie air-cJiambers
or caissons by the compressed air forced by the air-
pumps, that the air had to increase in density to
equalise by its pressure the outside pressure caused by
the water in the river.
10
Tlie atmospheric pressure had, consequently, to in-
crease also in the air-chamhers or caissons as the work
of excavation, removal of sand, and sinking of the piers
progressed, and when the caisson at the east pier
touched the bed of the river, the pressure was seventeen
pounds to the square inch exclusive of the fifteen pounds
of our ambient atmosphere.
The pressure increased gradually, and rose on the
28th February, 1870, when the east caisson touched the
rock, to forty -five pounds to the square inch, and by the
rise of the water in the river, during the months of
March and April, increased still more, so that on April
12th the pressure was fifty (50) pounds to the square
inch. The air being compressed to such an extent, and
men being obliged to work in it, it was supposed that it
might become injurious if their remaining in the air-
chambers was too prolonged. In consequence, the men at
work were directed to remain in the air-cTiamhers only
two hours at a time, with two hours rest between each-
two hours work, three times a day, making six hours in
all for a day's work.
The sinking of the caissons and the building of the
piers over them progressed, but, notwithstanding all the
precautions taken, the pressure increasing every day in
the air-chambers, and having reached twenty -four pounds
to the square inch, the caisson being then fifteen feet in
the sand at the east pier, and fifty feet under the surface
of the river where the men were working, then, some
of those at the east pier, after coming out of the air-
chambers, and when in the air-loclc, or after leaving the
air-lock, and returning into the normal atmosphere, com-
menced to suffer and complain of very severe pains
in the arms and legs, and sometimes of sliooting pains
in the back. None were affected when in the air cham-
bers or caisson, but alioays after returning into the
air-lock, or going out of the air-lock anul returning to
the normal atmosphere.
11
The sinking of the piers becoming deeper, the pres-
sure also increased, and when it had reached thirty -four
pounds to the square inch, the men became more
seriously affected ; some of them with violent epigastric
pains, and others with paresis, and some with slight
paraplegia, of which they generally recovered in from
twenty-four to forty-eight hours. Sometimes the para-
plegia was more severe, and some were taken with still
more serious symptoms, as paraplegia, involving the
bladder g'and rectum. Notwithstanding the existing
paralysis, some of those affected complained of violent
pains about the middle of the spine, and radiating in
every direction of the lower half of the body.
As soon as cases happened means were devised at the
bridge to relieve the sufferers if possible, even tempo-
rarily, and afterwards they were sent to the City
Hospital. (The first case sent to the Hospital was on
the 15th February, 1870.) Some died shortly after their
arrival at the Hospital, and some after a sojourn there.
Inquests were held by the Coroner of the County on the
bodies of those who died.
After the recurrence of such facts and accidents, phy-
sicians were called at the bridge to see the men at work,
and when taken sick, which was generally the case
when coming out of the air-lock, or after returning into
the normal atmosphere. None, and we repeat it from
official authority, were taken sick in the air-chamhers,
and the sufferers were generally taken, in from a few
minutes to one hour after they returned into the normal
atmosphere, and in two ca^es only did it occur in the air-
lock as soon as the door opened into the normal atmos-
phere, and not in the air-chambers or caisson.
At the inquests held by the Coroner, and after the
post mortem examinations on the bodies of the men
who died at the City Hospital, the opinions about such
cases, given by two medical gentlemen of this city, were
12
sustained, and their descriptions of the pathological
changes given, were published in newspapers and
medical journals.
We admit the correctness of their pathological obser-
vations on the patients, which they have called bridge
cases, as also their description of the pathological
changes observed during the post mortem examinations,
but we differ on the cause or causes' which produce or
have produced those pathological symptoms, as also
the pathological changes, and even death of the patients,
which have come under their observation, and we will
relate our own experience, and the observations made
by us in the caissons, at the bridge, and on the men
engaged at work in the air-chambers.
Having been for over six years Mr. J. B. Eabs""
physician, and meeting him frequently, we had the
opportunity of becoming initiated in the furtherance of
his great project to build an arched bridge across the
Mississippi river at St. Louis ; and with the means and
devices of engineering which he intended to employ for
prosecuting the work, and sinking of the piers, we became
so interested in the matter, that from the time the project
became a reality by the commencement of the work,
we thought that questions of great importance to sci-
entilic men would be met with, and that the use of
compressed air to exclude entirely the water from the
air-chambers or caissons, sunk at the depth of one hun-
dred and' fifteen feet^ and perhaps inore^ below the
surfa.ce of the river, {work never performed^ before at such
a depth, the deepest ever before reached being sixty-
five feet ;) that the air used at such a depth would have
to be condensed to a pressure as high, may be, as
fifty -five pounds to the square inch, and would certainly
require close observations in its use as it might pro-
duce on the men therein engaged pathological phe-
nomenas, with more or less serious effects on health
3,nd life.
13
Hence, from the first day of the sinking of the caisson
for the east pier, in November, 1869, we commenced ob-
servations and experiments, which we will have under
consideration, the perusal of which may, at first, seem
uninteresting, but the reader will find them necessary
to a full understanding of the subject we have under-
taken.
Al
CHAPTER II.
PHYLOSOPHICAL OBSEEVATIOJSTS ON THE USTFLUENCE OE
COMPEESSED AIR AND ITS PHYSIOLOGICAL EFFECTS ON
MAN.
The ambient atmosphere in which we live, is of all
things to man, the most necessary to life and to th^
preservation of health ; and if, by circuhM stances depen-
dent or independent of his will, the respirable air in
which he has to live, even for a short time, is undergoing
some changes in its normal condition, his organism may
be effected by it, his health impaired, even severely
compromised, and in some cases death may be the
result, if Ms remaining in certain abnormal atmospliere
Tias heen too prolonged.
The air may vary in its constituents according to
temperature and barometrical changes, having more
water at one time than at another, but is always in such
normal condition as to sustain life, that man can live
in it and be in good health, but if the condition of the
atmosphere is changed, not in proportion of its con-
stituents, hut in its density, as in a compressed atmos-
phere to a high pressure, as it is in the air-chamhers at
the bridge, the men to live in such abnormal atmosphere,
to work and to sustain life, may stand it well for a
certain length of time, but this very limited, and only by
taking the necessary precautions to avoid a too sudden
transition from the normal atmosphere to an over-
condensed one in which they are temporarily at work,
and then return again, all at once, into the normal atmos-
phere where human beings can live in good health.
In the normal atmosphere, which surrounds us, the
pressure is fifteen pounds to the scjuare inch on every
15
part of our body, but still we do not feel this pressure
when we move or during severe muscular exertions, as
in hard work. Consequently, for the sake of con-
xienience and clearness on the subject we ha^ee under
consideration, we will count only the atmospheric pres-
sure resulting from the height of water a'bo'ce the air-
chambers or caissons under the piers, exclusive of the
fifteen pounds of our ambient atmosphere.
The first time we were in the caissons, the pressure
was only five (5) pounds to the square inch. We were
not affected in any way ; we remained in them twenty
minutes, and afterwards we went twice a week, when
the pressure was increasing about one pound per day.
Still we did not feel any inconvenience, and it was only
when the caissons had touched the bed of the river, the
pressure having increased to sixteen pounds to the
square inch, that for the first time, in going through the
air-lock, we felt a pressure upon both tympanis — pres-
sure of which we relieved ourselves by swallowing some
of the air to produce contrepressure ; our breathing was
20 per minute and free ; our pulse, from 81 per minute
when normal, rose to 89. Three minutes after we were
in the air-lock or intermediate chamber, we felt a pain
in the frontal region which lasted about two minutes ;
we were six minutes going through the air-lock, that is
to say, passing from the normal atmosphere to a pres-
sure of sixteen pounds to the square inch, existing in
the caisson or air-chambers. Once in the air-chambers
we felt as well as in the normal atmosphere. After
fifteen minutes sojourn in the caisson, our pulse fell
again to 81 per minute, being the same as in the normal
atmosphere. We remained half an hour longer in the
caisson, going round examining the works, and before
returning into the air-lock, our pulse was only 75 per
minute, but from which we felt no inconvenience.
When in the air-lock in order to return to the normal
atmosphere, our stay was only four minutes, our pulse
16
remained the same, 75 per minute only. We felt cold
after being two minutes in tlie air-lock, the temperature
decreasing rapidly, the cause being the too rapid escape
of the compressed air through a valve which was open for
the purpose of equalizing the pressure with the normal
atmosphere in the shaft, and to allow the door to open
to return into the open air.
We successively visited the air-chambers every four
or five days without any inconvenience, and until the
caisson had sunk to sixty-nine feet below the surface
of the river, and the atmospheric pressure had increased
to thirty -two and one half pounds to the square inch.
On the two last visits we were longer in going through
the air-lock and felt more inconvenience from the frontal
pain. Our pulse rose to 100 per minute during our
stay in the air-lock \ our breathing remained free,
but was 21 per minute and continued the same while
remaining in the air-chambers.
We remained in the air-chambers thirty minutes^
after which time our pulse was only 72 per minute ; and
during our sojourn in the air-lock^ to return to the
normal atmosphere, we felt the same inconvenience of
cold, by the too rapid escape of the compressed air, the
temperature decreasing still more rapidly ; we remained
only six minutes in the air-lock on our return to the
normal atmosphere, and after opening the door leading
to the shaft and in ascending the stairs we had to
rest two or three times^ being exhausted and breathing
heamly. From that day we were perfectly satisfied
that the men liaving to work ever}- day in such an
ambient atmosphere, and with the prospect of increas-
ing pressure, might at any time sntfer find even become
affected with very serioas symptoms. Then we con-
tinued our visits at the piers and at the
lOAoT riKlt, FiiBBiiAUT KITH, .1870—11 o'clock, A. M.
Barometei' 29° 4o', the tliermometer 53° ; weather clear.
The caisaou being sixty -nine feet under the surface of
17
the river, the pressure being thirty-two and one half
pounds to the square inch in the air-chambers, we com-
menced to make systematic and regular observations,
as follows :
(For our observations and experiments we used ther-
mometers of Farenheit, made by Greener, from Berlin.)
There were six of us to go down in the caisson or air-
chambers : I, forty-six years old, and the other five
averaging twenty-nine years.
Our pulse were respectively, 81—78—78—79—79—80
per minute, regular and healthy. The measures of our
chest were, after inspiration, 40 inches — 37J — 37 — 37J —
37—351, and after expiration, 38— 36— 35— 35|— 35— 34.
The complexion and general appearance of each was
healthy.'
After descending the circular stairs, which lead to the
air-lock at the bottom of the shaft, the thermometer
was [56% There were in the air-lock at the time we
reached the bottom of the shaft, eight persons just
coming out of the air-chambers. We entered the air-
lock^ being seven persons, six of us and the lock-tender.
The door was closed, the valrie from the air-chanihers
opened to let the corn>pressed air enter the air-lock and
equalize the pressure as in the air-chambers or caisson.
We were ten {10) minutes in the air-lock to equalize the
pressure with the air-chambers. Four of our number felt
no inconvenience except complaining of a pain of their
tympanis, of which they relieved themselves by swal-
lowing some of the air, the lock-tender at the same time
relenting the ingress of the compressed air in the air-
lock. The thermometer was 56° when we entered the
air-lock and rose in seven minutes to 62°.
Our pulse before entering the air-lock were respect-
ively 81 — 78 — 78—70 — 79 — 80 per minute, and six min-
utes after rose to 100—88—98—86—95—90 per minute.
As the equalization of pressure took place in the air-
lock as in the air-chambers, and by opening the door
18
from the air-lock to the air-chamlDers we entered them,
the pressure being at the time "thirty-two and one half
pounds to the square inch, and the thermometer indi-
cating 48°. After remaining twenty minutes in the air-
chambers, we felt a marked exhilaration through all
our system. We remained two hours in the air-
chambers, during which time we made observations, as
follows :
After two hours sojourn in the caisson, our pulse
from 81—78—78—79—79—80 when normal, fell to 68—
70—71—69—70—72 per minute.
In the measure of our chests there was no change for
inspiration or expiration with the normal atmosphere.
It will be observed that during the time we re-
mained in the caisson we used no muscular exertions
by any forced labor. We observed, also, during our
sojourn, that all of us, and the men working in the
air-chamber, were covered with profuse perspiration,
and this with the thermometer at only 48° Farenheit.
During the time we were in the caisson, we made
experiments and observations to ascertain the tempera-
ture of ebulition of different liquids at such a pressure.
The temperature of ebulition of water, sulphuric ether
and alcohol under atmospheric pressure had been ascer-
tained before, hut hy experiments made in tJie laboratory
only, and until this day it was not supposed possible
that experiments and observations on the influence of
pressure on the temperature of ebulition could be made
under the pressure of three or four atmospheres, or
forty -five pounds pressure to the square inch, exclusive
of the fifteen pounds of our ambient atmosphere, and
the observer to be exposed to such pressure himself
during his observations.
We therefore claim priority for the following observa-
tions made in such an ambient atmosphere.
We had a phitform made supported by four columns
three feet high, and insulated in tlieir' continuity with
19
the soil by glass rods resting on the sand at the bottom
of the air-chambers. The platform upon which the
experiments were to be made was insulated, and if there
was a current or an accumulation of electricity in tJie
air-chambers^ the result of the experiments would be
influenced as little as possible by it.
We heated one pint and a half of distilled water in a
red copper capsule ofl'ering thirty-seven square inches
of heating surface to a large alcohol lamp fitted with
three cotton wicks and containing six ounces of alcohol-
During the experiments two thermometers graduated
to five hundred degrees Farenheit, made by Greener
of Berlin, were used so as to compare the accuracy of
each and ascertain if there was any difference in the
result. Both thermometers marked 270 ° Farenheit
during the ebulition of distilled water. We repeated the
same experiment three times with the same result.
We experimented afterwards with a glass capsule of
the same capacity as the red copper one, and found that
the thermometer rose to 274° before ebulition.
We do not present this fact as a new one. The differ-
ence of temperature of ebulition in different kinds of
vessels, was observed before by Gay Lussac, a French
chemist, but in the normal atmosphere, where the tem-
perature rose from 212° Farenheit to 216|°: but we were
desirous to compare if the difference was proportionately
the same, between a metalic vessel and a glass one,
under a pressure of thirty-two and one half pounds to
the square inch, besides the fifteen pounds of the normal
atmosphere.
We repeated the same experiments with filtered Mis-
sissippi river water, the thermometer indicating 268°
during ebulition in a red copper vessel and 272° in a
glass one.
We noticed an interesting fact, but which we will
leave our readers to solve, and which was repeated
20
three times in successoin. It was that when the distilled
water was in ebulition in the red copper vessel, and the
thermometer indicating 270°, if we touched the platform
with our hand, the platform ceasing to be insulated,
by ourselves being in communication with the soil, the
thermometer fell three degrees in the course of a few
seconds and ebulition ceased temporarily, and recom-
menced when the thermometer rose to 270°, but only
after the platform became reinsulated from the soil by
the withdrawal of our hand from the platform.
After our experiments, and having remained two
hours in the caisson, the thermometer from 48° when
we entered rose to 50°. We then returned into the air-lock,
and after closing the door from the air-chamber, the
compressed air was left to escape in the shaft by the
escape valve, and thus equalize the j)ressure to open
the door to return into the normal atmosphere.
After leamng the air-cTiamhers and during our stay
in the air-locTc, we felt cold as in our subsequent visits,
even more so. The temperature decreased very rapidly
by the too rapid escape of the compressed air, and
after four minutes sojourn in the air-lock, the ther-
mometer, from 50° at our entrance, fell to 37°. We
were only five minutes and a half returning to the
normal atmosphere at the bottom of tbe shaft, where, on
examining the thermometer, we found the temperature
to be 50°, and before ascending the stairs our pulse was
69—70—69—71-68—72 per minute.
In returning to the normal atmosphere we had to
ascend the stairs, as we have said before ; in ascending
them some of us had to rest two or three times^ 'breatlilng
heavily^ and after returning to the surface of the pier our
pulse was 106— 104— 92— 94— 102— 99, and rather feeble,
the ai)pearan(^e of five oi us was pallid and sallow, one
had no notable change. This concluded the first regular
observation.
21
In order to avoid useless repetitions we will epitomise
the results of subsequent observations.
EAST PIER, FjiBBUARy 12th, 1870—11 o'clock, A. M.
Barometer "29'' 80'. Thermometer 28^. Weather clear
and cold. Caisson seventy-one feet below the surface
of the water. Pressure thirty-three and one half pounds
to the square inch.
We were four persons only. I, forty-six years old,
one thirty-foui-, one twenty-nine, and one thirty-two.
Before descending the stairs our pulse was resectively
81 — 81 — 74 — 74 per minute. The measure of our chests
were, after inspiration, 40 — 38 — 38 and 39 inches. After
expiration it was 38 — 36 — 35J and 36 inches. Our
general appearance and complexion healthy.
When we arrived at the bottom of the shaft, the tem-
perature was 46°. We entered the air-lock, four persons
beside the lock-tender, who was directed to let tJie com-
pressed air in very gradually^ so as to stay eleven (11)
minutes in the air.loc'k before the pressure should he
equalized icith the air-chamhers. On entering the air-
lock the temperature was 47°, but increased to 62°
during our stay there. Before entering the air-cham-
bers our pulse was 98 — 07 — 84 — 88 per minute ; our
breathing free but 21 respirations per minute. None of
us felt any pain in their tympanis, neither any other in-
convenience during the equalization of pressure with the
air-chambers in which the temperature was 46° when we
entered them. After being twenty minutes in the air-
chambers we felt that same exhilaration all through our
system observed before.
Then we repeated the experiments on the temperature
of ebulition on distilled water, Mississippi water.
Alcohol, sulphuric ether and chloroform, with the fol-
lowing results.
For the distilled water the thermometer marked 271°
in a red copper vessel and 274 J° in a glass one.
22
For Mississippi river filtered water the thermometer
marked 269° in a red copper vessel and 272^° in a glass
one.
The experiment of laying the hand on the platform,
to suspend its insulation was repeated ; the thermometer,
at each time insulation ceased, successively fell three
degrees, after a few seconds ebulition ceasing also, but
commenced again as soon as the thermometer rose to
the figure before observed, and by the reinsulation of
the platform by withdrawing the hand from it.
We proceeded afterwards to experiment on alcohol,
sulphuric ether and chloroform, for which a water bath
was used, and with the following results :
Alcohol in ebulition, 224°. (Alcohol fortius.)
Sulphuric ether in ebulition, 122°. (Ether fortior.)
Chloroform in ebulition, 179°. (Chloroform purifi-
catum.)
The experiments with alcohol, sulphuric ether and
chloroform were repeated three times with the same
results.
After our experiments were over, and having remained
two hours in the caisson, the temperature was 50°. Our
pulse from 81 — 81 — 78 — 78 when in the normal atmos-
phere fell to 66 — 68 — 66 — 69 after our sojourn in the air-
chambers. The measure of our chests were unchanged.
It was observed that during the time we were in the air-
chambers, we, as also all the working men, loere
perspiring profusely. During our sojourn in the air-
chambers our speech seemed changed, but after re-
peated observations of this phenomena we explained
it. According to the laws of acoustics, the air being
compressed at the pressure of thirty-three pounds
to the square inch above the normal atmosphere, the
undulations of sound or waves cannot be transmitted to
the ear tlirough a condensed atmosjjhere at such a pres-
sure with the same facility as through the normal one,
the pressure also affecting at the same time the sensi-
S8
bility of the anditif nerve, but temporarily, as did the
pain on the tympanis, after being a few minutes in the
air-lock. We say temporarily, because after some time
sojourn in the air-chambers this phenomena almost
ceased.
After leaving the air-chambers or caisson and re-
turning into the air-lock, in which we remfiained six
Tniniites, during this time the temperature from 45° in
entering it, fell to 34°; as the compressed air escaped
and the equalization of pressure taking place with the
normal atmosphere in the shaft, which we reached, and
after ascending the circular stairs we returned to the
surface of the pier.
We experienced, as before, the same hard breathing
and exhaustion, three or four times, in coming up ;
our pulse after returning to the normal atmosphere was
92 — 88 — 90 — 95 per minute ; the appearance of the en-
tire party was very sallow.
Ten minutes after returning to the normal atmos-
phere, the author commenced to feel a severe epigastric
pain, which was relieved by taking a table-spoonful of
a cordial ; on going home the pain left him completely,
but there was a general feeling of great fatigue, which
lasted about three hours, during which his pulse, from
92 per minute, fell to 81, its normal condition.
This concludes the second regular observation.
EAST PIER, Febbuaey 19tli, 1870—11 o'clock, A. M.
Barometer 29°, 36'. Thermometer 33°. Weather cloudy.
Pressure thirty-seven and one half pounds to the square
inch. Caisson eighty-one feet below the surface of the
water.
There were six persons to go down in the caisson.
The writer, three stranger visitors, and two working-
men. Our ages were one forty-six, tv/o thirty -two, and
three from twenty-eight to thirty years old. The appear-
ance of all was healthy, the complexion tolerably fair.
Our pulse respectively was 81 — 75 — 76 — 80 — 76 — 82 per
a2
24
minute. No measure of chest was taken having pre-
viously indicated no marked change in the several
preceding observations.
After descending to the bottom of the shaft, seven of
us, including the lock-tender, entered the air-lock^ where
we remained twel'oe minutes and a half for the equali-
zation of pressure with the air-charribers. None of us
felt any inconvenience during that time. When entering
the air-chambers the temperature was 45°. Our pulses
were 97 — 77 — ^77 — 92 — 88 — 90 per minute. Our respiration
was 21 per minute. The phenomena of alteration of the
sounds in our speech was observed to a greater degree
than on our preceding visit. We refer for the explana-
tion of this phenomena to our last observation. (Page
22.)
After experimenting again on the temperature of
ebulition, we obtained the following results :
For distilled water when in ebulition, in a red copper
vessel, the thermometer was . . - 280°
When in ebulition in a glass one, - - - 284^'
For Mississippi river filtered water, in a red
copper vessel, 277"
When in ebulition in a glass one, - " - - 280°
The same falling of the thermometer was observed
when the insulation of the platform ceased, by putting
our hand on it, but rose again in a few seconds after
withdrawing it. After remaining two hours in the
air-chambers our pulse was 64 — 70 — 67 — 69 — 68 — 68 per
minute.
Thinking that it was necessary to ascertain if there
was any appreciable quantity of carbonic acid in the air-
chambers, we experimented by shaking a large mouth
glass jar containing about two pints of fresh slackened
lime water, at different places and height in the caisson,
but without noticing any effervesence or milky appear-
ance in the lime water, which was, for the present,
sufficient proof that if there was any carbonic acid pre-
25
sent it must be a very small quantity. But what
became of tlie carbonic acid evolved by the respiration
of the workingmen, or from any other cause, we will
examine it hereafter.
Our experiments concluded, the thermometer was
45°. We then entered the air-lock to return into the
normal atmosphere, and directed the lock-tender to let
the compressed air escape very slowly so as to enable us
to remain at least seven minutes, to return in the shaft
or normal atmosphere.
During the seven minutes we were in the air-lock,
while returning '^to the normal atmosphere, the ther-
mometer, which was 45° when we entered it, fell to 32°,
gimng us an uncomfortahle sensation of cold, which
was only relieved by entering the shaft or normal
atmosphere, where the temperature was 59°. Our pulse
then was the same as in the air-chambers. After leaving
the air-lock and during the time we were ascending the
stairs in the shaft, we had to rest at different times,
breathing heamly, our pulse quickening, though not
losing its strength. Arrived at the surface of the pier,
our pulse was respectively 104 — 90 — 90 — 100 — 94 — 96 per
minute. Our appearance was very sallow and we felt
much fatigued.
Ten minutes after reaching the surface of the pier,
/ felt a Tiery severe epigasti^ic pain, which increased
while crossing the river to the shore. I then drank two
tea-spoonsful of old Jamaica Rum which relieved
me in a very few minutes, but the feeling of great
fatigue and depression of the system, which I expe-
rienced on my preceding visit, remained during four
and a half hours, compelling me to lie down until
evening.
This concluded the third regular observation.
I intended to continue my experiments and obsetTations on the 22d February,
but since my last visit to the caisson, I was so feeble that I thought best to
postpone them untU I felt better and stronger, and that I would wait until the
caisson had touched the rock.
26
EAST PIER, Februaby 28th, 1870—11 o'clock, A. M.
Barometer 29° 60'. Thermometer 34°. Weather clear.
Caisson touching the rock ninety-live feet below the
surface of the river. Pressure forty-five pounds to the
square inch.
Four of us went down, one forty-six, one thirty -four,
one thirty -two, and one twenty-nine years old. Before
descending the shaft our pulses were respectively 82 —
78 — 79 — 85 per minute. Our complexion was healthy
and fair. Arrived at the bottom of the shaft the ther-
mometer was 48°.
Four of us and the lock-tender entered the air-lock,
the compressed air was let in Tiery slowly, still slower
than on our preceding msit. It tooTc fifteen minutes
to equalize the pressure with the air-chambers. Our
pulses, after ten minutes in the air-lock, rose to 102
— 95 — 97 — 97. The thermometer, from 53° when we
entered, rose to 68°. Our respiration was 21 per minute.
On entering the air-chambers twenty minutes after, the
thermometer was 45° ; our pulses were respectively as
before descending the shaft, 82—78—79—85. Our
respiration continued 21 per minute. During our con-
versation the sonority of the voice was more affected
than on our preceding visit. The caisson touching the
rock, and being the deepest point to be reached, where
it would be possible to experiment, I continued my ob-
servations on the temperature of ebulition under high
pressure, with the following results.
Distilled water when in ebulition in a red copper vessel,
thermometer, 294°
When in a glass one, 297°
Mississippi filtered water, in a red copper vessel, 291°
When in a glass one, 294°
After having terminated our experiments, which
lasted two hours in the air-chambers, the temperature
was 45° ; we felt well and were ready to return to the
normal atmosphere, when Mr. J. B. Eads, happening
to he in the air-lock with a party of visitors, coming
27
down in the air-chambers, then / remained with them
three-quarters of an hour longer, and going around in
the several places where the caisson touched the rock,
and I waited until they returned into the air-lock in
order to go with them.
There were ten persons in the air-lock when the door
of the air-chambers was closed; the equalizing valve
opening into the shaft or open air was freely opened,
the compressed air escaping very rapidly, I felt the
same decrease of temperature as in my preceding visit,
and I was taken with a violent pain in the head, in the
region of the superior longitudinal sinus, — pain so
violent at a time that I asked that the escape of com-
pressed air might be lessened.
We were only three minutes and a half in the air-
lock, to return into the shaft or normajl atmosphere.
I was the last to leave the air-lock, not feeling very
well; and after resting four times in ascending the
stairs, I arrived at the surface of the pier, almost ex-
hausted, my pulse at 110 per minute. I sat down a few
minutes, but did not feel any better, I was taken
again with the same epigastric pain as in my former
visit, I was dizzy, so that no sooner was I on board
the boat which crossed us to shore than I had to sit
down on the stairs of the cabin to prevent myself from
falling ; my pulse grew weaker, and after reaching the
shore, I had to use great exertions to reach my buggy,
only half a square distant. I succeeded in getting in.
During that time the epigastric pain increased, having
nothing to take to relieve me, an accident in the caisson
having deprived me of my flask containing the cordial
which I intended to use in case of necessity, if suffering
as before from the same pain.
In the course 'of a few minutes I drove home, which I
reached at half-past two o'clock p.m., three-quarters of
an hour after leaving the air-chambers or caisson. The
28
last effort brouglit me to my office, where in a few-
minutes I became paralysed.
This concluded the fourth systematic regular obser-
vation.
Before proceeding farther, we must say that these
successive experiments on ebulition of water under in-
creased atmospheric pressure, which we made during
our preceding visits in the air-chambers of the east
caisson at the bridge, seem to have no relative interest
with the subject we have undertaken ; but when our
readers find that a liquid like water can be influenced
in its physical change from a liquid form to a gaseous
one or steam, by the increased atmospheric pressure,
and that then water is an inert body — if we found that
increased atmospheric pressure exerts such influence
on its physical transformation from a liquid form to a
gaseous one, is it not rational to infer the influence of
increased atmospheric pressure to a much greater de-
gree on an organized body as the human system ?
Therefore it was the reason we continued our re-
searches by experiments on the ebulition of water
under increased atmospheric pressure, and made also
our observations on the physiological effects and on the
pathological symptoms on the men working in the air-
chambers in the caissons at the bridge.
CHAPTEK m.
PEESONAL EXPERIENCE BY THE WRITER — TAKEN SICK
AND PARALYSED AETER COMING OUT OF THE CAISSON
— HIS OWN PATHOLOGICAL OBSERVATIONS, TREATMENT,
AND RECOVERY.
Being in my ofl3.ce paralysed and unable to speak
for a few minutes, but conscious of what was passing
around, I made signs to my wife and persons with, her
at the time not to move me at all, but to lower my head
and to raise my feet as high as possible. In the course
of a few minutes, I was able to articulate a few words,
but with great efltbrt, and to say what should be done
to me. / was to he left perfectly quiet on my hack or
my right side, my head ori a leml with my hody, my
legs stretched, and my feet elertated two feet dbone my
head.
Then I took a tea-spoonful of old Jamaica rum every
five minutes three times in succession, and kept a small
piece of ice in my mouth to quench my thirst. A few
minutes after I commenced taking two large table-
spoonsful of beef tea every five minutes. I was suffer-
ing from profuse cold perspiration, every effort to speak
caused great suffering and fainting, my pulse was 106
per minute, both legs and my left arm were paralysed,
still I was suffering in both with excruciating pains
which I can only compare to pains felt after a fracture
of the left leg, which I experienced some years ago.
During the pains in my limbs, which increased at
intervals, my pulse was 115 per minute.
I knew well that in my situation, as I said to my
wife, that after doing all I directed to be done, if I was
no better by half-past five o'clock that same evening
that nothing more could be done.
A3
30
About half an hour after reacMng home, three o'clock
P.M., my pulse was 100 per minute, but a little stronger ;
the pains were not so frequent, but as severe ; it was
impossible for me to move my legs and my left arm.
Any attempt to remove my clothing occasioned fainting.
I directed that I should be left perfectly quiet, but
from time to time to be turned only from my back on
my right side, but with the greatest care, the least
deviation of my body or any part of it increasing the
intensity of my sufferings.
At half-past three o'clock p.m., I felt some better ; my
pulse was 100 per minute, but a little stronger. I was
still taking beef tea every ten minutes, and kept using
ice. The pains were not so frequent, but as strong,
in the legs and left arm.
At forty-five minutes past three o'clock p.m., I felt
sleepy, and dozed about ten minutes, after which I felt
much better and stronger, but was still paralysed. The
perspiration was still very profuse, but not so cold, and
being very thirsty, I continued the ice. I commenced
to be relieved of the pains in my limbs, and felt that I
was gaining strength, my pulse being 96 per minute,
and stronger. I slept about twenty minutes ; and at
half-past five o'clock p.m., three hours after reaching
home, I was undressed and put to bed.
I had use only of my right arm, and noticed that
after 'being removed to my bed the paralysis had in-
creased^ but this increase remained temporarily. Some
time after I was in bed I felt more comfortable; my
head was kept very low, my legs and feet were raised
by pillows a foot above my head, and lying on my
back or on my right side.
At six o'clock P.M., the profuse perspiration ceased ;
my pulse remained 96 per minute, but full, with symp-
toms of fever, which gradually increased until half-past
seven o'clock p.m., at which time / considered myself
out of immediate danger. The pains in the left arm
31
and both legs were less frequent. I had intervals of
comparative ease. At half-past nine o'clock p.m., I
commenced to move my legs a little, as also my left
arm.
I had no disposition to sleep. At half-past eleven
P.M., the pain had left my left arm, and I was able to
move it ; but the pains had located in both knees, and
was so intense as to cause me to groan. My pulse was
still 96 per minute and full ; my skin hot but moist.
At half-past two o'clock a.m. I slept, but was
awakened from time to time by the suffering when
trying to move ; after half-past three o'clock a.m. I
commenced to move my legs. Shortly after four
o'clock A.M. I slept, and did not awake until after
seven o'clock a.m., when I was able to sit up in my
bed, but felt very weak, my pulse being 92 per minute,
and my skin warm and moist.
I had not any micturition since the preceding morn-
ing at ten o'clock, and in order to do so, it was only
after trying four different times, that I succeeded in
passing some very dark-colored urine, hut not bloody.
After dressing I tried to walk. I succeeded, but it
was only on a smooth floor. For more than two hours
after, I could not raise my feet higher than four inches
from the floor ; for a week I was rather feeble, but after
that time I recovered my strength rapidly.
This recital of my experience as a patient may seem
to be lengthy. It is nothing else but what I ex-
perienced, and it was full of suggestions of what I
would have to do if I was professionally called to
attend similar cases.
CHAPTER IV.
PATHOLOGICAL SYMPTOMS OBSERVED AMONG THE MEIST
WORKING IJSr THE AIR-CHAMBERS — THE REMEDIES USED
AS CURATIVE AND PREVENTIVE ARE INEFFICIENT,
During my preceding visits at the "bridge before I
was taken sick, and when the caisson at the east pier
was fifty feet (50) below the surface of the river and
fifteen (15) feet in the sand, the pressure 24 pounds to
the square inch, the men were worTiing in the air-
chaTribers six hours 'per day, two hours at a time, with
two hours rest between each time of worTc, when some
of them commenced to complain of epigastric pain and
cramps in the arms and legs, but principally in the
legs. In most cases, after a few hours of rest, the pains
disappeared, and the men returned to work. Some
were taken again, and with increased violence ; some
were suffering with parepsis of both legs, which ob-
liged the men so attacked to discontinue work for a
day or more ; and some were suffering from complete
paraplegia, involving the bladder and rectum, which
disabled them from anj^ further work in the air-
chambers.
By the advice of somebody, the men were ordered to
wear a voltaic belt around the bodj^, or a voltaic sole to
be worn in each shoe or boot, between the sole and the
foot, or two voltaic bracelets to be worn around each
wrist, — the voltaic element being composed of a series
of zinc and silver plates overlapping each other about
one-eighth of one inch, said voltaic apparatus intended
as a preveutive and cure for the pains the men who were
worMng in the caissons complained of.
During our visits to the bridge, we saw many of the
men wearing tliese voltaic apparatus, and by careful
33
enquiry^ we did not hear that much henejit had been
derited from their use; for we saw men taTcen with
Xiery se'dere pains, who had been and were still wearing
soles, belts, and bracelets, and were taTcen sicJc after
coming out ; and among them some became paralysed
while wearing the apparatus, and some even died wear-
ing them.
Again, some claimed that the " Magic Oil," a kind of
patent liniment, was a sure cure for those pains and
cramps caused by working in the air-chambers. It was
used freely in frictions on the men as soon as they were
complaining, but without any marked benefit.
Then another preparation called " King of Pains,"
claiming to operate wonderful cures on the pier patients
(as the sellers of this nostrum were pleased to call the
suffering men who had worked in the air-chambers)
was also used — internally in small doses, and exter-
nally in large quantities — but without any more suc-
cess than attended the voltaic plates or magic oil or
liniment.
Magneto-Electricity, produced by a magneto -electric
machine, was also tried on the men as soon as they
complained, but no favorable or permanent result was
obtained by its use in the cases which were subjected
to it.
Warm baths and e'oen hot baths were resorted to to
relieve the sufferers, but with no marked benefit, except
to stop for a while their pains; but as soon as they
were removed from the bath, the pains returned ; and
some were paralysed while in the bath, or immediately
after.
Notwithstanding all the attempts to prevent, cure, or
relieve the sufferers, the number of cases increased
daily. Cases of paraplegia occurred frequently, ^ so
that on February 15th, some of the men were actually
sent to the city hospital.
CHAPTER y.
DEATH OF SOME OF THE MEN" — USTQUESTS BY THE OOEOISTER
— POST MORTEM EXAMHSTATIONS, AlVTD OPIlSTIOlSrS OF -SOME
OF THE PHYSICIANS PEESEISTT AT THE INQUESTS.
The work of sinking the piers progressed, but the
pressure increasing also in the air-chambers, the num-
ber of cases became more frequent, and as soon as a
man was taken sick he was sent to the city hospital.
On the 21st March, 1870, twenty cases had been sent
to the hospital ; live died — two within a few hours after
their admittance.
Inquests were held by the coroner, and post mortem
examinations made.
Of those five post mortem examinations, tlwee are
copied from the reports gwen ~by the coroner^ and tlie
tioo others from reports printed in the daily papers
and medical journals, which we here reproduce.
FIRST POST MORTEM EXAMIISTATION.
James Moran, 35 years old, Ireland, admitted in the
hospital on the 10th March, 1870, died on the 19th of
the same month, nine days after his admittance.
When sent to the hospital he had never been but two
hours in the caissons.
The spinal column was first opened, in dissecting
down to the dorsal muscles ; the veins were found to be
very numerous and distended, with dark and tarry
blood. The vascularity signally increased with the
approach to the spine.
On removing the vertebral arches, and exposing the
dura mater, the cellular tissue exhibited great vascu-
larity and reddish gelatinous infiltration. The dura
35
mater was separated from the spinal cord by a copious
collection of serum, fluctuating on pressure, and chang-
ing its level in altering the position of the body.
The serum was not collected and measured, but was
estimated at about two ounces. Leaving the spinal
cord and its membranes in situ, we proceeded to the
cranial cavity, and removed brain and spinal cord
together.
The arachnoide membrane of both brain and cord
was intensely vascular; its vessels of larger calibre;
the structure succulent, and at various places of the
brain changed in thickness and transparency, and
covered with inflammatory products of a whitish-grey
hue, besides being raised -off by subarachnoide serous
infiltration. The consistency of the substance of both
organs was on that occasion but superficially inquired
into, inasmuch as a microscopic examination is pur-
posed.
In pressing on the spinal cord, some elastic resistance
was observed, which proved to be serum in its canal, so
much accumulated in that space that, being pressed
from two opposite directions, it would distend the cord
cylindrically. Near the cauda a moderately-sized vein
waa_cDniplfiteIy.JtromiQaed. f p \
The right side of the heart was filled^ with cj)agulated
fi^rine,^ which extended into the pulmonarv^artery ;
whereas the left side contained some blood of a dark
appearance, not coagulated. The lungs were well in-
flated ; anteriorly they were of normal color, but
posteriorly darkened from hypostasis. The kidneys,
slightly enlarged, showed venous congestion. There
was hemorrhagic infiltration about the junction of the
cortical and medullary substance. Ureters normal.
About the bladder, and extending below the perito-
neum backward and upward, there was extravasion
of blood without any mechanical lesion. The bladder
itself, although ,,;^butv^containin^y> a small quantity of
36
urine mixed with blood, was collapsed, and from pre-
vious distension far larger tlian usual. The mucous
membranes thickened, softened, and discolored.
Intestines, liver, and spleen were marked by hypos-
tatic conditions, with extravasion of blood.
SECOND POST MORTEM EXAMIISTATION.
Gr. S. Alt, 22 years ; nativity, Germany ; admitted in
the hospital March 10th, 1870, after working two hours
in the caissons ; died, March 22d.
The brain and spinal cord were found highly con-
gested, the latter being softened in many places to
pulpy consistency. There was evident subarachnoid
effusion, and probably more that that a normal quan-
tity of fluid in the dura mater of the cord. Small clots
of extra vasated blood were found at different points on
the external surface of the latter membrane. All the
abdominal visceras were surcharged with blood, the
lungs suffering less in this respect than any of the other
organs. There were clots of blood found in both kid-
neys ; one of the ureters was very much enlarged.
THIRD POST MORTEM EXAMUNTATION.
Henry Krausman, 27 years ; nativity, Germany ;
admitted in the hospital, March 22d; died 23d same
month.
The whole contents of the cranium were found highly
congested, with effusion beneath the arachnoid, the
vessels of the latter membrane being highly injected.
Blood oozed freely from the substance of tlie brain on
section. The spinal cord presented pathological con-
ditions precisely like those of the brain, with the addi-
tion of the existence of clots of extravased blood at
different points inside of the dura mater; there was
also a congested condition of the thoracic content, less'
marked probably in the lungs than in the other organs.
The abdominal visceras were very highly congested,
37
with extravasion of blood in tlie kidneys. The mucous
membranes of the bladder was healthy, and a small
quantity of bloody urine was in the bladder.
FOUETH POST MOKTEM EXAMnTATION..
Theodoee Louis Baum, 21 years; nativity, Ger-
many ; admitted in the hospital, 22d March, 1870 ;
died, 23d same month.
On examining the contents of the cranium, the sub-
stance of the brain was found overcharged with blood,
oozing freely from minute points on section. The
meninges were also highly congested, and consider-
able serous effusion between them, most marked under
the arachnoid. The spinal canal was also opened and
examined, and about the same condition existed here
as in the brain. The effusion under the dura mater
was well marked. There was also found in the inside
of the dura mater at several points small clots of extra-
vased blood. In examining the thorax, the small
capillaries of the pleura and pericardium were found
highly injected. The lungs very highly congested, but
much less than the other organs. All the abdominal
visceras were intensely congested; clots of extrava-
sed blood were found in the kidneys, and small dark
patches on the mucous membrane of the bladder, re-
sembling ecchymosis.
FIFTH POST MOETEM EXAMESTATION.
Geoege Baeeows, 22 years ; nativity. United States ;
admitted to the hospital the 1st of April; died the
12th.
The brain and spinal cord and its meninges were
found congested, and with slight sub-arachnoid effu-
sion. The thoracic visceras were found normal, except
some slight adhesions of the pleura.
On opening the abdomen, the intestines and the peri-
toneum were found highly inflamed, with extensive
adhesions between them. The bladder and rectum
38
were found gangrenous, the former having been per-
forated by ulcerations, discharging its contents of
bloody urine into the peritoneum.
The opinions given on those cases by two medical
gentlemen of this city, and who were present at the
post mortem examinations, are literally copied as
follows.
The first opinion given was tJiat tTie affection hy
wMch tlie laborers in the air-GJiamJbers are attacked is
cliiejly attributed to tTie cTiange from a Tiery condensed
to a Gomparatii^ely rarified atmospTi.ere.
Second Opinion. — " In fact, I heliene the greatest
danger to persons entering the caissons is that they
enter too rapidly / that if they would admit the pres-
sure more moderately, so that the heart and internal
organs accommodate themselves more gradually to this
process of congestion. And as to- the manner of coming
out of the air-lock, / should think it advisable to come
out as rapidly as possible ; for in every case, whether
they suffer or not, there must take place a certain
degree of reaction to the surface of the body, which
is only aecoonplished by the removal of the atmospheric
pressure in entering the open airP
We will refer hereafter in our analysis to the opinions
enunciated by those two medical gentlemen.
CHAPTER YI.
NUMBER OF CASES STILL INCREASE AMONG THE MEN —
DEATHS AT THE PIERS — THE WRITER TAKES CHARGE
OF THE MEN WORKING IN THE AIR-CHAMBERS — MODI-
FICATIONS IN THE DURATION OF TIME OF WORK PER
DAY — SYSTEMATIC DIRECTION GIVEN FOR REMAINING
IN THE AIR-LOCK.
No precise or even proximate cause of tlie patho-
logical phenomena, based on facts, could be adduced,
nor was any prophylactic means advised in order to
avoid the recurrence of such cases.
In taking charge of the men, Ave found them as
follows :
There were at the east pier 80 men working in the
air-chambers, divided into gangs from eight to ten,
with a foreman for each gang.
Their appearance was generally healthy and cheerful ;
their pulse ranged from 75 to 82 per minute.
Their nationality was nearly equally divided between
United States, Ireland, and Germany, with the excep-
tion of five Frenchmen and four Englishmen. Their
ages averaged as follows : — Five were from 17 to 20
years, fifty-three from 20 to 28, sixteen from 30 to 36,
and six were over 40 years old. With a few excep-
tions their stature was rather below the medium height.
Twelve were married. As a generality, they were in-
telligent, every one of them being able to read and
write. As for their character, some were docile, easy
to manage ; some wilful and unruly.
Their habits were not very regular, except a few —
many of them were using strong drinks rather too
freely, and the most of them chewing tobacco. As to
B
40
their diet, a great part of the men were not taking a
regular dinner, but going to shore, taking a lunch with
one or two drinks, or even more, instead of a substan-
tial but plain dinner.
When the writer took charge of the workingmen,
there was at the east pier a flat boat, which had a
cabin to receive temporarily the men taken sick.
This was immediately improved by large additions
for accommodation, so that at least fourteen patients
could be attended in the floating hospital. A room
was also provided on the same boat, with berths for
each man to rest during the interval allowed to them
between their time of work in the air-chambers.
The duration of work was two (2) hours three (3)
times a day, with an interval for rest of two (2) hours
between each two (2) hours work.
Prior to the 31st March the men, as soon as they
came out of the air-chambers, were allowed to go
ashore, provided they were ready to return with their
gang at their regular time of working in the air-
chambers.
The appearance of the men when coming up into the
open air was pallid and sallow ; the pulse of some
quick, ranging from 90 to 110 per minute ; but with
others it was the contrary — the pulse was as low as 60
per minute. All the men invariably in coming out of
the air-chambers, after ascending the shaft, and once
in the open air, complained of fatigue ; but instead of
resting by sitting or lying down, and keeping quiet for
half an hour at least, they were running around and
going to shore to take a drink or more. The conse-
quence was, that when the time to return to the air-
chambers ai)proached, they hastened to the shaft to go
down, and instead of being refreshed and to have re-
covered some strength, they were going down to work
41
again, in a condensed atmosphere, more exhaustive to
human organism than any kind of work performed in
the open air.
Such was the state of things when we took charge of
the men at the bridge.
Having experienced ourselves the exhaustive power
of a condensed atmosphere, very nearly equal to the
pressure to which the men had to work — being 48 pounds
to the square inch— we thought a change between the
time of work was necessary, that is to say, we sug-
gested that they should work six hours per day,
divided into three watches of two hours each, but with
three hours rest instead of two between each two hours
of work.
We instructed also the air-lock tender {pie man in
charge of the air-lock) for the duration of time that
the men had to stay in the air-lock when going to
work in the air-chambers or when coming out of them.
This had not been regulated, and had been left to the
option of the air-lock tender ; and it so happened that
when the men were going to work, if they had with
them a new or green hand, as they called him, they
enjoyed the fun of letting the compressed air to come
in very fast, and' instead^ of being sixteen {16) minutes
in the air-lock, when the pressure was 48 pounds to the
square inch — to equalize the pressure with the air-cham-
bers or caissons — 'they were only Jme to six minutes,
which time was not only too short bnt injurious to
some of them.
Bnt it was still worse for the men themselves work-
ing in the air-chambers, when, after two hours working,
and anxious to come out into the open air, they were
going through the air-lock still quicker^ as for instance,
in three or four minutes, instead of seven or eight
minutes, which time they ought to have remained.
Then we directed that every air-lock tender should
always, when taking a gang of workmen and going
42
from the air-lock into the air-chamlbers, should take one
TThinute to every three pounds of pressure until the
equalization between the air-lock and the air-charribers
or caissons, — that is to say, 16 minutes for 48 pounds
pressure ; and when going out through the air-lock,
from the air-charribers to the normal atmosphere, one
minute to every six pounds, — that is to say, eight
minutes, to let the compressed air in the air-lock
escape into the shaft and to return into the open air.
By my directions, every man working in the air-
chambers who should be taken sick was to be removed
immediately to the floating hospital at the east pier,
to receive the necessary attendance, and that under no
circumstances should any one he removed from the pier
to any other place — having given special directions for
the treatment of those taken sick during my temporary
absence — being convinced, after the careful observation
of some cases, that any removal or transportoMon of
the men taken sick aggraroated, their case, and might in
some cases involve life.
After increasing the time of rest between the two
hours work, no case occurred until the 4th of April.-
CHAPTER VII.
DECREASE OF FATAL OASES — SEVENTY-EIGHT CASES OF
OBSERVATIONS AND TREATMENT — RECOVERY — SYSTE-
MATIC EXAMINATIONS OF THE MEN WORKING IN THE
AIR-CHAMBERS — PROPHYLACTIC TREATMENT.
At the east pier, tlie pressure being increased to fifty
(50) ponnds to the square inch by the rise of water in
the river, the men again commenced to suffer and com-
plain ; and I then observed that symptoms of exhaus-
tion prevailed always on a man, when he complained
of being sick, after coming out of the air-chambers. It
was evident to me that the waste on the system of
those men was going on faster when working in the
air-chambers than on any other man working in the
open atmosphere.
I observed also that when a man was taken sick
immediately after coming out of the air-chambers his
pulse was 95 to 115 per minute and feeble ; but that the
contrary happened on those taken sick after a lapse of
twenty minutes or longer, their pulse being generally
slow — very often as slow as ^60 per minute. Either,
when taken sick, was covered with cold profuse per-
spiration. The temperature of the body was not much
changed, except the legs, which in most serious cases
were cold and the skin clammy. The pupils remained
unchanged, the face was pale and livid, and the lips
discolored ; but this, after from five to ten minutes,
ceased after the patient had been lying down and at
perfect rest, and his legs more elevated than the head.
After repeated observations of similar cases, I pre-
scribed the following treatment, the success of which
44
will be demonstrated I) y the perusal of the hrst forty-
nine cases which came under our care during a regular
attendance at the bridge from the 31st March, 1870,
until the 27th May following.
I directed that the voorhliig luen^ as soon as they
were coming up from the air 'Chambers, should rest and
keep quiet for an hour, and if any were taken sick the
treatment was to be as follows :
The patient was to be put in bed lying on his back
or right side, the head low — level with the body, the
legs stretched, the feet elevated at least one foot above
the head, and all clothing loosened.
I prescribed half an ounce of the following cordial,
which always relieved the violent epigastric pains :
R. Spiritus Jamaicensis, - viii. fluid ounces.
Syrupus simplex, - iv. fluid ounces.
Oleum anisi, - - ii. fluid drrchms.
After taking this cordial, and from five to ten minutes
after, it was followed by two table spoonsful of beef
tea (made with Liebig's extract of meat in the propor-
tion of one drachm to six ounces of boiling water), two
tablespoonsful was given from five to ten minutes ; and
as the patient always after a while complained of thirst,
ice was freely used, but no water or any other drink
was allowed for at least two hours.
The beef tea was continued regularly ; the position
of the patient was still adhered to ; but afterward the
legs were left in the most comfortable position, as soon
as the pulse was getting stronger and less frequent,
that is to say, for the cases where the pulse was over
95 per minute and feeble, and more frequent in the
cases where the pulse had fallen as low as 60 per
minute. Then, and not until then, was the patient
allowed to change his position.
The necessity of placing the i)atieiit on his back, with
the head low and the feet elevated, was to send more
stimulus to the brain, and prevent a return of syncope,
45
which sometimes happened, and which, if repeated in a
state of exhaustion, might have had a fatal termination.
And when the position was alternately changed from
the back to the right side, it was to relieve the spine,
and at the same time the heart, to let it resume its
regular function, which was more or less disturbed at
the time the x^^tient was taken sick. No bath of any
kind was given to any of the sufterers, having been
positively forbidden by me.
The tirst case which occuiTed after commencing my
regular attendance at the bridge, was on the fourth of
April, and was afterwards followed by others, as the
data of observation in each case will show. I was
unable then to control the men and persuade them to
keep quiet and rest" after coming up from their work, as
also to prevent them from going ashore, where a great
many were drinking freely, and, it will be seen, that
before I got control over them, that is to say, from the
fourth of April until the twenty -hfth of the same month,
thirty cases occurred.
From repeated observations the variation of the tem-
perature of the normal atmosphere did not seem to have
any marked influence on the men working in the air-
chambers, nor did the barometrical changes, as it was at
iirst supposed, and this is the reason we have thought it
necessary to note at the head of each case the state of
the barometer, thermometer and appearance of the
weather, as also the pressure then existing in the air-
chambers.
(.:ASE I. — Aebil 4:Th.
East Pier. Barometer 29° 44'. Thermometer 50.
Weather clear. Pressure forty-eight pounds to the
square inch.
William Wilson, twenty-two years ; nativity, United
States ; medium stature ; worked three weeks in the
caissons ; taken sick for the first time, after a two hours'
watch, at eleven o'clock, A. M., two hours after coming
up.
Bl
46
SYMPTOMS.
Face livid, pulse 66 per minute. Complained of vio-
lent epigastric pain, as also of shooting pains in back
and left arm. There are manifest signs of paraplegia.
TEEATMENT.
Half an ounce of cordial ; kept at perfect rest in bed,
in the position already prescribed ; two table-spoonsful
of beef tea every ten minutes ; when thirsty, ice. Con-
tinued the same for one hour, after which, the pulse 70
per minute ; beef tea every twenty minhtes and kept at
rest for one hour longer ; the epigastric pain and pain in
back nearly disappeared, and also the symptoms of
paraplegia ; motion has returned. Six o'clock P. M.;
pulse 76 per minute ; appearance good. Asks to go
home by himself, which is granted. Rested two days,
and recommenced work.
CASE II.— April 5th.
East pier. Barometer 59° 45'. Thermometer 60°.
Weather clear. Pressure fort3^-eight pounds to the
square inch.
G. Lyons. (Foreman.) Thirty years ; nativity, Penn-
sylvania; worked nearly live months, and since the
caissons were submerged; was taken sick after the
third watch of two hours ; said himself that he did not
rest between the last two watches he worked the day
he was taken sick. It was about twenty-five minutes
after coming out of the air-chambers that he was taken
with violent epigastric pain and parepsis of both legs.
Being myself absent at the time, a liot bath was given
to him to relieve the pains, of which he was free as long
as he remained in the bath, but as soon as he was out
of it he was taken with paralysis of both legs and left
arm, and shortly after the pains returned.
He was sent home in an ambulance, within three-
quarters of an hour after being taken sick. I saw the
]>atient one hour or so after he was removed to his
horn*.';. The patient was of medium statui'e, and well
built.
47
SYMPTOMS.
Face pallid, pulse 64 per minute — paraplegia was
complete. The legs were both cold and shrunken, and
of cyanotic color; notwithstanding the paraplegia he
was complaining of shooting pains in both legs and
lower part of the back.
TREATMENT.
Perfect rest in bed in the position already described.
The patient not having taken any food for nearly
twelve hours, two ounces of beef tea was given every
half hour for three hours, and then the same continued
every hour for four hours, after which the patient felt
better, the pulse being 69 per minute. He slept a little,
but was awakened by shooting pains in the legs and
back. The bladder, being also paralysed, had not been
emptied of its contents since morning. After examina-
tion, finding the bladder very distended, I used a cath-
eter and drew two pints of urine, which was highly
colored, but limpid and not bloody.
5th April. — Patient better ; pulse 70 per minute ;
slept, but still complained of violent epigastric pain,
which ceased as soon as the beef tea was taken. The
legs are in the same condition ; the bladder being again
full and paraplegia existing, he has to be catheterised
three times every twenty -four hours. 6th April. — Pa-
tient same ; pulse 75 per minute ; slept well, and has no
more epigastric pain ; asks fox something to eat, which
is granted. Catheterism is used three times a day,
during which time the quantity of urine passed is at
least half a gallon, and of normal appearance. 8th April,
Same ; pulse 75 per minute ; slept well ; appetite good ;
the patient commenced to use the catheter himself to
relieve the bladder three times every twenty -four hours,
and drew the same quantity of water as before. April
9th. — Pulse 75 per minute ; good appetite ; catheterised
himself three times. 10th. — Same condition ; had no
stool since he was taken sick. 11th. — Same ; continued
the use of the catheter three times a day, 10th. — Same ;
48
pulse 75 per minute ; slept well ; appetite good, but no
stool yet. Prescribed one enema witli two pints of
tepid water and two fluid draclims of tincture of
assafsedita, which, after its administration, produced
a constipated evacuation. April 14th. — Patient better ;
pulse 76 per minute ; skin soft and warm ; the
paraplegia partially ceased ; patient feels whenever
anybody touches his legs and feet, and is able to
move them a little ; he can urinate, but with diffi-
culty. From the 14th until the 30th, there was no
notable change in the state of the patient. May 1st.
— Same ; pulse 78 per minute ; commenced to sit up ;
can move his legs more freely, but each motion is suc-
ceeded by involuntary tremor. May 3d. — Still improving
until the 23d, when he was able to sit up in an easy
chair, but for want of proper nursing had to be removed
to St. Luke's Hospital to insure the necessary nursing.
May 25tli. — Removed to St. Luke's Hospital ; still im-
proving ; urinates freely four or live times in twenty-
four hours, but is obliged to use an enema every other
day to produce an evacuation from the bowels. May
28th. — Still improving ; sat up two hours at a time, three
times a day. June 10th. — Pulse 80 per minute and
strong ; has a daily stool without enema. Commenced
to stand on his feet and walk with some assistance.
24th. — Still improving ; pulse 80 per minute ; can walk
by himself by using a chair as a support. 28th. — Com-
menced to use crutches and go around. July 8th. — Left
the crutches and used two canes instead, and no longer
needed to look at his feet when walking. 18th. — Same ;
intend to leave the hospital ; imj)roving, but slowly, and
unable to walk without the use of two canes.
CASE HI. — April 5tu.
East pier. Barometer 29° 94'. Thermometer 60°.
Weather clear. Pressure tifty pounds to the square
inch.
11. IvKLLoa, tlurty years; nativi y, England; worked
six weeks ; was taken sick for tlii^ first time after the
49
third watch, and from twenty to twenty-five minutes
after coming up. Patient of medium size, well built.
SYMPTOMS.
Face livid ; pulse 6(5 per minute ; complained of vio-
lent epigastric pain, also pains in both legs, which were
moved with diflB.culty. Followed the same treatment as
in case No. 1, and in six hours the patient was much
better ; pulse 78 per minute, when he was removed to
his home. April 6th. — Slept well ; pulse 80 per minute ;
felt much better, but weak ; intends to rest a few days
before working again.
CASE IV.— Apkil 5xh.
East pier. Barometer 29° 94'. Thermometer 60°.
Weather clear. Pressure fifty pounds to the square
inch.
JoHJsr Yager, thirty-three years ; nativity, Germany ;
worked three weeks ; taken sick for the first time after
the third watch, and twenty-five minutes after coming
up. Patient is of medium stature and well built.
SYMPTOMS.
Face very livid, and covered with profuse perspira-
tion ; pulse 64 per minute ; violent epigastric pain ; also
pain in both legs and left arm.
TREATMENT.
Same as case No. 1 during one hour, after which the
pulse is 70 per minute. Continued beef tea every half
hour for six hours longer, when the pulse is 76 per
minute, and the pains in both legs and left arm have
ceased. Twelve hours after having been taken sick, he
was able to go home by himself, but he remained weak
for sometime, preventing him from returning to the same
work.
CASE v.— Apbil 6th.
East Pier. Barometer 29° 88'. Thermometer 63°.
Weather clear. Pressure fifty pounds to the square inch.
Charles Lovejoy, (foreman,) thirty-three years ;
nativity, United States ; worked three months in the
50
caissons ; had suffered three times before of pains in Ms
legs, principally in the knees, of which he recovered
easily, and recommenced work the following day. This
time he was taken sick after the third watch, and half
an hour after coming out of the air-chambers.
SYMPTOMS.
Suffered with violent epigastric pains, and of slight
paraplegia ; notwithstanding the marked state of par-
alysis the patient was complaining of shooting pains
in both legs ; face palid, and covered with profuse per-
spiration ; pulse 66 per minute.
TEEATMENT.
Same as case No. 1, during an hour, after which the
pulse was 72 per minute ; continued beef tea every half
hour for four hours longer and used ice, the patient
being thirsty ;. perfect rest for eight hours from the time
he was taken sick, when he was sent home. Saw him
the following morning : pulse 80 per minute ; felt well,
but w eak ; did not think him fit to work any longer in
the caissons, and had Mm removed to some other work.
Notwithstanding all the care taken, having had five new
cases in the last two days, of which case II. was a very
serious one, it became necessary to reduce the duration
of time of worlc to two watches of two hours each^ with
four hours rest hetween each two hours worTc, maTcing
only four hours for a day^s loorlc, and this only every
twenty -four hours. But it availed us little, as it was
impossible to keep the men ac rest after coming up
from the air-chamhers^ as they would still run around
or go ashore to indulge in drinking. Immediately
after their last watch was over, the majority of them,
instead of taking time to rest or wash themselves, were .
running for the boat to go ashore, where, instead of
going home to keep quiet and rest, the most of them
were wasting their time of repose in bar-rooms or other
places unlit for any man employed in such exhausting-
work.
51
We were convinced that it was necessary for strict
regulations to be enforced to prevent among the men an
increase of new cases, and that a favorable result could
only be obtained by compelling them to take more reg-
ular and systematic rest between their time of work —
rest indispensahle for repairing the loaste caused on
tTieir organism hy worMng in the highly condensed^
atmosphere of the air-chambers — but to enforce these
rules and regulations for their own benefit was next to
impossible. All we could do was, when new cases
occurred, to try our best to relieve the sufferers. On
the following day we had —
CASE VI,— Apbil 7th.
East pier. Barometer 29° 80'. Thermometer 60°.
Weather cloudy. Pressure fifty pounds to the square
inch.
Chas. Dufourny, forty-four years ; nativity, France ;
worked four weeks ; was taken sick after the last watch,
immediately after coming up; tall, slender build.
SYMPTOMS.
Face livid ; lips discolored ; skin cold and covered
with profuse perspiration ; pulse 110 per minute and
feeble ; complained of violent epigastric pain ; also, of
shooting pains in both legs.
TREATMENT.
Perfect rest, in same position as before described ;
given half an ounce of cordial, followed, five minutes
after, by two ounces of beef tea, continued every
ten minutes for an hour, after which the pulse
was 90 per minute ; continued the beef tea every hour
during six hours longer, when the pulse was 85 per
minute, and the patient felt well enough to be sent
home ; following morning felt well. After examination
found him unfit for working in the air-chambers, and he
discharged accordingly.
52
By the following case (7) it will he seen how dijfficul
it was to enforce the regulations :
CASb: VII.^Apbil 8th.
East pier. Barometer 29° 88'. Thermometer 60°.
Weather cloudj^. Pressure fifty pounds to the square
inch.
Louis Boyee, twenty -four years; nativity, France.
This patient had only worked two hours for the first
time, on the first of April, when he was taken sick with
epigastric pain and parepsis of ',both legs, half an hour
after coming up from the air-chambers. After resting a
few days he intended to return to the same work, but
before doing so, and after I had examined him, I told
him not to go into the caissons any more, because he
was unfit for such work. jSTotwithstanding my advice,
he came with a friend the following morning to work in
the air-chambers, and was taken sick the same day after
the second watch, and after coming out of the air-lock.
Instead of taking him to the lloating hospital to receive
proper treatment, he was removed to his boarding house
by the same friend with whom he came to work in the
morning. I saw the patient only six hours after his
removal and found him as follows,- tall but very slender.
SYMPTOMS.
Face hot; pulse 96 per minute. Paraplegia had
supervened during his removal to his home. The
bladder was full and distended; the catheter was
used, and oyerjialf a gallon of urine of a dark color
but clear, and containing no blood, was drawn. After
the catheterism he felt much relieved, and in less than
twenty minutes his pulse fell to 90 per minute. The
thirst being very great ice was kept in the mouth, and
two ounces of beef tea was given every hour. Cathe-
terism was used again late in the evening, which drew
the same (Quantity and quality of urine.
April 9th. — The patient has not slept, and suffered in
the night of shooting pains in the back and both legs,
53
which are still paralysed, cold and shrunken ; toward
morning the water had to be drawn ; the quantity had
slightly diminished ; the catheter had to be used twice in
the day ; the patient was restless, and the pulse 95 per
minute.
April 10th. — Patient more restless ; pulse 98 per min-
ute ; no appetite ; skin hot and dry ; catheterism used
again. There being no suitable accommodation for a
sick person he was removed to St. Luke's Hospital to
remain under my care. 6 o'clock, p. m. Same ; pulse
95 per minute ; continued the use of the catheter.
April 11th. — Felt worse ; had a chill in the night,
which was followed by strong fever ; pulse 110 per
minute and full ; paraplegia still existing ; had to be
catheterised during the night, the filling up of the blad-
der causing such violent pain that from this time the
catheterism had to be used every eight hours regularly.
April 12th. — Had fever ; pulse 100 per minute and
full ; no appetite, but a parching thirst ; catheterised
every eight hours and given a teaspoonful of spirit of
nitre with two tablespoonsful of water every two hours.
April 13th. — Pulse 100 per minute ; slept better ; no
appetite; same thirst; catheterised three times a day ;
continued the spirits of nitre every two hours.
April 14th. — Better ; slept well ; pulse 85 per minute ;
but the urine drawn in the night contained a large
quantity of pus, which settled at the bottom of. the
vase. Bowels not evacuated since taken sick ; prescribed
an enema with two fluid drachms of tincture assafsetida
and two pints of tepid water, which, after administra-
tion, produced a large evacuation. Since last night the
patient can feel and move his legs a little ; catheterism
is still necessary every eight hours.
April 15th. — Better; pulse 85 per minute; appetite
returning ; thirst ceased ; had two involuntary stools :
urine is drawn three times a day, each "time containing
a large quantity of pus. The quantity of urine in
twenty-four hours, has been seven pints by measure-
ment, even more, since the 11th.
54
April 16tli. — Pulse 85 per minute ; slept well ; good
appetite ; felt and moved his legs better ; catlieterism
still used three times a day.
April 17th. — Same, but moved both legs more freely.
April 18th. — Has been restless all night ; pulse 90 per
minute ; had two involuntary stools, and felt a desire
to urinate, but without success. Continued the cathe-
terism three times every twenty -four hours. The urine,
containing a larger quantity of pus than before, has be-
come very foetide, principally immediately after being
drawn.
April 19th. — Pulse 85 per minute ; same feeling of
urinating, but without any result; catheterism still
continued every eight hours; same quantity of pus in
the urine as before, and urine very foetide.
April 20th. — Patient better ; slept well ; pulse 82 per
minute ; good appetite ; the pains in the legs have
ceased, and he moved them freely; same feeling to
urinate, but still obliged to have recourse to catheter-
ism every eight hours.
April 21st. — Pulse 85 per minute ; has urinated him-
self twice during the night.
April 22d. — Pulse 90 per minute ; skin clammy ;
urinate freely, but the foetidity of the urine has in-
creased, and is becoming ammoniacal, besides still
containing a large quantity of pus. Then I prescribed
to talj:e a teaspoonful every six liours of the following
mixture :
each ii. Huid drachms.
Spiritus camphorse,
Spiritus nitri duL,
Lupulina, . . . . i, drachm.
Mucilage accacifg, - - ii. Huid ounces.
April 23d. — Pulse 84 per minute ; urinated every
three or four hours ; the bowels are regular ; appetite
good; continued the mixture every six hours.
April 24th. — Pulse 80 per minute; felt better; con-
tinued the same.
55
April 25tli. — Pulse 80 per mimite, but urine contain-
ing still more pus, and very foetide.
April 26tli. — Pulse 90 per minute ; more pus in the
urine ; emptied the bladder with a large silver catheter,
then washed the bladder with a very diluted solution
of carbolic acid, in the proportion of two fluid drachms
of the solution of carbolic acid for half a pint of tepid
water.
April 27th. — Pulse 85 per minute ; urine better, but
still containing a great deal of pus ; repeated the same
washing of the bladder morning and evening.
April 28th. — Pulse 85 ; slept well ; urinated only
every four or five hours, but there is still some pus
in the urine ; pumped the bladder with a great deal
of care, and washed it by injection of the same solution
of carbolic acid used since the 26th.
April 29th. — Pulse 85 ; less pus in the urine, which
is clear, and, after settling, does not decompose so
readily ; appetite good ; slept well ; the legs have re-
covered their regular motion,
April 30th. — Pulse 85 per minute ; feels better, and
good appetite ; pumped the bladder and washed it again
with the same injection as used before, and which, when
drawn, was colored with a small quantity of blood.
May 1st. — Pulse 85 per minute ; patient feels weak,
which I attributed to the successive injections of the
bladder ; had no stool for four days ; prescribed a pill
three times a day, containing one and a half grain of
quinine with one grain extract of rhubarb.
May 2d. — Pulse 82 per minute ; urinated about every
two hours ; great deal less of pus in the urine.
May 3d. — Pulse 82 ; slept well ; can sit up ; urine
better, and pus still diminishing ; continued the pills
three times a day.
May 4th. — Same ; improving, and urine without pus.
May 5th and 6th. — Same ; no pus perceptible in urine,
only after it had settled for some hours ; bowels regular.
0
May Sfh. Pulse 80 per minnte ; slept well ; good
appetite ; feels stronger.
May lOtli. — Same ; improving fast ; can stand up for
the first time since taken sick ; no pus in tke urine, even
after settling.
Mav 12tli, 14tli, 16tli, IStk. — Same ; slept well ; vora-
cious appetite ; bowels regular ; urine clear and natural.
May SOtli. — Same ; improving ; commenced to walk.
May 22d. — Still improving ; pulse 82 per minute.
May 25tli. — Same.
May 28tli. — Same.
May 31st. — Pulse 80 per minute ; improving ; urine
clear and normal ; bowels regular.
June 1st. — Same ; walked out doors, a distance of
three squares, for the first time since Ms admittance in
the hospital.
June 4th. Same, and repeated his walk.
June 6th, 8th, 10th, 12th. — Walks every day to gain
strength.
June 20th. — Feels well ; pulse 81 per minute ; dis-
charged from St. Luke's Hospital, and will resume work
in a few days.
CASE VIII.— Apbil 8th.
West pier. Barometer 29° 70'. Thermometer 62°.
Weather cloudy. Pressure forty pounds to the square
inch.
E. S. JoHisrsoE", thirty years ; nativity. United States ;
worked three weeks ; was taken sick about twenty
minutes after coming out of the air-chambers, and after
the first watch of two hours ; said he had not taken any
breakfast. The patient was of medium stature and
well built.
SYMPTOMS.
Face sallow ; complained of violent epigastric pain,
and parapsis of both legs and left arm ; pulse 68 per
minute ; felt drowsy.
57
TEEATMENT.
Same as case I.; after one hour's rest pulse was 72 per
minute ; continued the beef tea every half hour for three
hours longer, after which the pulse was 75 per minute ;
kept him at perfect rest for six hours longer, when he
was sent home,
April 9th. — Patient well, but will need a few days
rest before recommencing work.
CASE IX.— Apeil 9th.
East pier. Barometer 29° 70'. Thermometer 58°.
Weather cloudy. Pressure fifty pounds to the square
inch.
JoHJsr Kelset, thirty-six years ; nativity, Ireland ;
worked three weeks ; was taken sick for the first time
after the second watch, and immediately after coming
up ; above medium stature, well built.
SYMPTOMS.
Face livid ; pulse 115 per minute and feeble ; body
covered with profuse perspiration ; paresis supervened
as soon as taken sick.
TREATMENT.
Same as case I. ; after one hour pulse 90 per minute ;
continued the beef tea every hour for four hours longer,
after which the patient felt better ; pulse 85 per minute
and stronger ; moved his legs ; kept all night at perfect
rest, and on the morning of April 10th was improving,
but felt weak ; slept well ; pulse 85 per minute. Sent
him home and cautioned him against going into the air-
chambers, as he was unfit for such work.
CASS X,— Apkil 9th.
West Pier. Barometer 29° 70'. Thermometer 58°.
Weather cloudy. Pressure forty pounds to the square
inch.
George Harris, twenty-five years ; nativity, United
States ; worked but three days, and was taken sick half
an hour after coming up from the last watch of two
hours. Patient of medium stature, well built.
58
SYMPTOMS.
Face livid, and covered with profuse perspiration;
pulse 60 per minute ; complained of violent epigastric
pain.
TEEATMEJSTT.
Half an ounce of cordial, repeated after five minutes,
and followed by two ounces of beef tea every ten min-
utes ; perfect rest in tlie position already indicated ;
continued the beef tea for two hours, when the pulse
was 98 per minute ; continued the same treatment for
two hours longer after which pulse 72 ; kept him at per-
fect rest all night.
April 10th. — The patient feels well, his pulse being 78
per minute, and he is able to go home.
CASE XL— Apbil 9th.
East pier. Barometer 29° 70'. Thermometer 58°.
Weather cloudy. Pressure fifty pounds to the square
inch.
G. M. McCaetey, twenty -four years ; nativity, Ire-
land ; worked about two weeks ; taken sick after the
second watch, and immediately after coming up. The
patient is of medium stature and well built.
SYMPTOMS.
Face livid, and covered with profuse perspiration ;
pulse 100 per minute ; complained of violent epigastric
pain, and paresis of both legs.
TEEATMENT.
As before for one hour ; pulse then 72 per minute and
stronger ; continued the same for two hours, when pulse
87 per minute ; patient complaining of great thirst ice
was used ; kept him at perfect rest three hours longer,
when the paresis disappeared, and he was able to move
his legs quite freely. After remaining quiet two hours
longer, feeling well [and stronger, he was able to go
home.
59
CASE Xn.— April 9th.
East Pier. Barometer 29° 70'. Thermometer 58°.
Weather cloudy. Pressure fifty pounds to the square
inch. •
Hansep Miller, twenty years ; nativity, Germany ;
worked nine weeks ; taken sick after the second watch,
and immediately after coming up. The patient is of
medium stature, slenderly "built.
SYMPTOMS.
Face livid ; lips discolored , pulse 110 per minute and
feeble; complained of violent epigastric pain, which
caused him to faint twice.
TEEATMEISTT.
Half an ounce of cordial, repeated after five minutes,
and followed by two ounces of beef tea every ten min-
utes for one hour ; perfect rest, and after one hour,
pulse 94 per minute and stronger; patient being much
better, / left Mm, directing what was to he done until
my return ; but fifteen minutes after my departure, feel-
ing shooting pains in both legs, Tie demanded that a hot
hath should he ginen to him, and, notwithstanding, that
I had forhidden that a hath of any Mnd he gimn to
patients, it was done. After remaining about five
minutes in the bath, he became paralysed in both legs
and left arm, in which state I found him on my return,
after an hour's absence. His pulse was 92 per minute,
and despite the existing paraplegia, he was complaining
of shooting pains in both legs and back. He had not
passed any urine since 11 o'clock, a. m., and was suffer-
ing from its accumulation in the bladder. Catheterism
had to be used which drew about one pint and a half of
a highly colored but clear urine. The beef tea was con-
tinued every two hours during the night, as well as ice,
the patient complaining of great thirst.
April 10th, 6 o'clock a.m. — Pulse 90 per minute ; slept
a little, but was awakened by epigastric pain, returning
from time to time. Catheterism had to be used to
empty the bladder, which contained two pints of dark
60
but clear urine. Seeing no prospect for tMs patient to
imjprove for the present, lie was removed to his home.
April 11th. — -Same state ; pulse 85 per minute ; cathe-
terism morning and evening.
April 12th. — Pulse 84 per minute ; slept well ; same
state of the paraplegia.
April 13th — Same ; pulse 84 per minute ; catheterism
twice a day.
April 14th, 15th, 16th, and 17th. — Same ; had no stool
since taken sick. Prescribed an enema with two
drachms of tincture of assafoetida and two pints of
tepid water, which, after its administration, was fol-
lowed by a large evacuation.
April 18th. — Pulse 84 per minute ; appetite good ;
slept well, but no change concerning the paraplegia.
The catheterism of the bladder had to be repeated
twice a day. From this day until the 28th there was
no change, but on the morning of the 29th, when turned
on his right side, the urine contained in the bladder
escaped involuntarily. It happened also on the morn-
ing of the 29th, before seeing him ; and to satisfy
myself that the bladder was really empty, I introduced
a catheter, but without drawing any urine.
May 1st. — Pulse 80 per minute ; appetite good ; could
turn in bed by using his arms, but there was no favor-
able change in the paraplegia. Prom the 3d May until
the 21st, the patient remained in the same condition.
On the 24th, 27th, and 30th, a current of magneto-
electricity was used once, and then twice a day, but
without producing any result.
June 2d. — Pulse 80 per minute ; same state ; the
patient asked to be removed to St. Luke's Hospital,
so that he miglit remain under my care. From the day
of his removal until the 15th, there was no change.
The pulse was 85 per minute and weak ; and notwith-
standing the constant care taken to tarn him from side
to side, large gangrenous sores appeared in the region
61
of the sacrum, and on botli trochanters. Solution of
carbolic acid was used for dressing, and I prescribed
one grain of quinine to be taken every six hours, and
beef tea and wine to be taken every three hours
regularly.
From June 16th until the 31st, same; pulse 84 per
minute; the sloughing of the bed sores well circum-
scribed; the solution of carbolic acid continued for
dressing ; quinine, wine, and beef tea continued.
From the 22d until the 28th June, no change; but
involuntary tremors are observed in both legs if the
patient was even slightly moved. ^
June 29th. — Involuntary stools commenced, and as
often as four times a day. Fifteen drops of tincture
of opium was given every six hours, but without any
result.
June 30th. — The tincture of opium continued; the
pulse is 92 per minute ; patient taken with vomiting,
which, is stopped only with sparkling soda water ; the
tincture of opium discontinued.
July 1st. — Patient somewhat better ; vomiting ceased ;
pulse 85 per minute ; the involuntary tremor in both
legs has ceased.
July 2d. — Pulse 84 per minute ; no appetite ; the in-
continence of urine is still persisting, as also the
involuntary stools. The legs are still paralysed. From
this day until the 27th, the state of the patient has
remained the same. On the 28th, the patient was
desirous of returning home, and was removed on the"
29th.
July 29th. — Visited the patient ; pulse 80 per minute ;
heathy granulations forming on all the bed sores, which
were discharging a healthy pus ; no marked ameliora-
tion in the paraplegia.
July 30th. — Same ; the tremor in the legs has re-
appeared, and there is no amelioration in the state of
the patient.
ol
62
CASE Xnr.— Apeil 11th.
East pier. Barometer 29° 79'. Thermometer 67°.
Weather clear. Pressure 50 pounds to the square inch.
Olive AisrDERSOisr, 27 years ; nativity, United States ;
worked about two weeks ; was taken sick after the last
watch of two hours, about twenty minutes after coming
up ; above medium stature and well built.
SYMPTOMS.
Face pale, pulse 65 per minute, complained of violent
epigastric pain, and feeling very weak.
TREATMENT.
Same as before for two hours, after which the patient
felt much better ; the epigastric pain ceased ; pulse 80
per minute ; kept him at rest for three hours longer;
after which he was allowed to go home.
CASE XIV.— Apbil 11th.
West Pier. Barometer 29° 79'. Thermometer 77°.
Weather clear. Pressure 40 pounds to the square inch.
Philips Bryan, 27 years ; nativity, Ireland ; had
never worked in the caissons before, and was taken
sick after the second watch of two hours, and twenty
minutes after returning to the open air ; tall, but
slenderly built.
SYMPTOMS.
Face pale, and covered with profuse perspiration ;
pulse 68 per minute ; complained of violent epigastric
pain, and paresis of both legs.
TREATMENT.
Same for two hours, after which the pulse was 75 per
minute, the epigastric pain nearly ceased, and the legs
nearly free fi'om paresis. Kept him at rest six hours
longer, after which pulse 78 per minute, and felt well
enough to go home ; but after examining him before
leaving, he was found unfit to work in the air-chambers,
and is accordingly discharged.
63
CASE XV.— Apeu, 11th.
West Pier. Barometer 29° 75'. Thermometer 75°.
Weather clear. Pressure 40 pounds to the square inch.
William Schultz, 32 years ; nativity, Germany ;
vp-orked four weeks, and had suffered three times before
of slight epigastric pains, but after half a day's rest
returned to work. He was taken sick this time after
the last watch, and three quarters of an hour after
coming up, and having already returned home, . where
I saw him. He is of medium stature and slenderly
built.
SYMPTOMS.
Face pale; complained of epigastric pain, and of
parapsis of both legs and left arm ; pulse 69 per
minute.
TREATMENT.
Same ; twelve hours after the pulse was 82 per
minute, but weak; the parapsis has ceased. After
examination, finding him unfit for working in the air-
chambers, he was advised not to return to the same
work.
CASE XVI.— Apbil 11th.
West Pier. Barometer 29° 75'. Thermometer 67°.
Weather clear. Pressure 40 pounds to the square inch.
Pateick Henley, 28 years ; nativity, Ireland ; had
never worked in the caissons before, and was taken
sick after the first watch of two hours, and about
twenty minutes after coming up. Above medium
stature, and well built.
SYMPTOMS.
Face livid, and covered with profuse perspiration;
pulse 60 per minute ; had had, within a few minutes,
two syncopes, from which he recovered, his face having
been bathed with ice water, and by lying in bed with
his legs stretched and his feet elevated above his head ;
he complained of violent epigastric pain and paresis of
both legs.
64
TEEATMENT
As before during one hour, after which, the patient felt
better ; pulse 70 per minute ; continued the beef tea
every half hour, and the use of ice. After three hours'
rest, from the time he was taken sick, the pulse rose to
78 per minute, and paresis ceased ; kept him all night
at the floating hospital, and on the following morning,
(April 12th,) his pulse was 80 per minute and strong ;
he felt well enough to go home by himself.
CASE XVII.— Apeil 12th.
"West pier. Barometer 29° 85'. Thermometer 62°.
Weather clear. Pressure forty pounds to the square
inch.
. James Aistdkews, twenty-eight years ; nativity, Den-
mark ; had never worked in the caissons before ; was
taken sick after the first watch of two hours which he
had ever worked, and immediately after coming up ;
was carried to the hospital in an insensible condition.
The patient is of medium size and well built.
SYMPTOMS.
Face livid and swollen ; lips discolored ; pulse 110 per
minute and very feeble ; both legs and the left arm com-
pletely paralysed ; the whole body was covered with a
cold and profuse perspiration.
teeatment.
Half an ounce of cordial, repeated every five minutes
for three times, and followed by two ounces of beef tea
every ten minutes ; perfect rest in the same position as
before described during one hour, when the pulse
was 95 per minute and a little stronger ; continued the
beef tea every half hour for three hours longer ; pulse
then 85 per minute, and the patient able to speak for
the first time since he was taken sick. Upon ques-
tioning him, he said that he had been drinking very
freely for the last year, but was sober this day before
going into the air-chambers. During the following six
i
65
hours tliere was no change in his condition, and reten-
tion of urine existing, catheterism was used and two
pints of dark colored, but not bloody, urine was drawn.
April 13th. — Condition of the patient still the same ;
same pulse ; catheterised twice a day.
April 14th, 8 a. m. — There being no prospect of im-
provement for the present in the condition of the patient,
he was removed to St. Luke's hospital.
April 15th. — Same condition ; slept a little ; very little
appetite and weak ; pulse 85 per minute but feeble ; ca-
theterised morning and evening, and the quantity and
quality of urine drawn the same ; prescribed as diet beef
tea, milk, eggs and wine.
April 16th, 17th, 18th, 19th.— Same ; pulse 85 per
minute but still feeble ; catheterised every six hours, the
patient complaining of violent pain as soon as the blad-
der became a little distended; had no stool since he
was taken sick; prescribed an enema with two drachms
tincture assafsetida and two pints tepid water, which,
after its administration, produced a large evacuation.
April 20th, 21st, 22d, 23d, 24th.— Same condition;
patient weaker ; still catheterised every six hours ; had
no stool since he had an enema, which was repeated
and followed by a large evacuation.
April 25th. — Pulse 90 per minute and feeble ; had an
involuntary stool in the night, and incontinence of urine
supervened instead of retention ; patient very weak ; no
appetite, and very thirsty.
April 26th, 27th, 28th, 29th.— Same condition.
April 30th. — Pulse 100 per minute and very feeble ;
incontinence of urine and involuntary stools became
more frequent. Large gangrenous sores have com-
menced on the sacral region and on both trochanters,
notwithstanding all the care taken to turn the patient
from side to side every two hours, and to keep him as
clean as possible.
66^
May 1st. — Pulse 110 per minute and weak ; the bed
sores spreading, and the general appearance indicates
that the patient is sinking.
May 2d, 3d, 4th, 5th, 6th. — Same ; pulse 120 per min-
ute ; patient sinking very fast.
May 7th. — Died at 7 o'clock, a. m.
Post mortem examination held ten hours after death.
Cranium. The vessels of the pia mater were full and
distended. There were extensive adhesions of old
standing, said adhesions between the fold of the dura
mater, descending in the interlobular fissure separating
the two hemispheres of the brain. The brain, on inspec-
tion, was found healthy and firm to the touch, but two
ounces of serum was found in the ventricules. The
spinal column was not opened," but two ounces of serum
was collected while escaping from the vertebral canal
when removing the brain.
The Heart. The right ventricle contained a fibrinous
clot extending to the pulmonary artery ; the left ventricle
contained fibrous clots and a bloody clot, and some two
ounces of a dark liquid. The liver was of normal size,
but of a slight nutmeg color. The spleen was four times
as large in all proportions as in the normal state, but
.of normal consistence. The lungs were normal, well
inflated, but there were adherences to the chest around
the base of the right one. The kidneys were both larger
than usual, the right one being the largest ; both were
soft, and the upper part of the parenchyne of each had
a gangrenous patch of the size of a silver half dollar.
The chalices contained no pus ; the urethers of both
were enlarged near their entrance to the bladder.
The bladder was contracted and contained some pus,
and the walls were thicker than usual ; there was no
enlargement of the prostate gland. The stomach was
apparently normal, but contained about a pint of
greenish liquid. The ileum and jejunum were slightly
congested.
67
CASE XVin,— Apbel 12th.
West pier. Barometer 29° 85'. Thermometer 72°.
Weather clear. Pressure forty pounds to the square
inch.
Hugh Devel, twenty-eight years; nativity, United
States ; worked in the caissons only from the morning;
taken sick after the second watch, and about twenty
minutes after coming up ; above medium stature.
SYMPTOMS.
Face pale, and covered with profuse perspiration;
pulse 64 per minute and weak ; complained of epigastric
pain, and of paresis of both legs.
TEEATMENT.
Same for one hour, pulse then 72 per minute; con-
tinued the beef tea every half hour ; kept at perfect rest
for two hours, when the pulse is 76 per minute and
stronger ; the paresis of both legs has ceased ; was
kept all night at the floating hospital, and on the fol-
lowing morning was much better ; pulse 80 per minute
and good ; was able to go home without assistance.
CASE XIX.— Apeil 12th
East Pier. Barometer 29° 85'. Thermometer 72°.
Weather clear. Pressure fifty-two pounds to the square
inch.
G. DoNELLY, (foreman,) thirty-two years, nativity,
Ireland ; worked three months ; had epigastric pains
three times ; he recovered each time and resumed work
after a day or two's rest. This time, when taken sick
was after the last watch, and half an hour after coming
up ; of medium stature and slenderly built.
SYMPTOMS.
Face livid ; complained of violent epigastric pain and
paraplegia ; pulse 65 per minute and weak.
TREATMEISTT.
As before for one hour, after which, pulse 70 per
minute and stronger ; rest for two hours when the pulse
68
is 75 per minute ; could move his legs a little, and tlie
epigastric pain left him ; kept him at perfect rest until
the following morning. ^
April 13th. — The patient much hetter ; pulse 80 per
minute ; can move his legs better but not freely.
April 14th. — Pulse 80 and good; paraplegia com-
pletely ceased.
April 15th. — Much better and sitting up. After resting
a few days he had entirely recovered.
CASE XX.— Apkil 14th.
West pier. Barometer 29° 60'. Thermometer 80°.
Weather clear. Pressure forty pounds to the square
inch.
GrEOEGE Haas, twenty-five years ; nativity, Germany ;
had worked only three days in the caissons ; was taken
sick after the last watch, immediately after coming up.
He is above medium stature and slenderly built.
SYMPTOMS.
Brought to the hospital in a syncopal condition, before
which, he said, he was suffering of epigastric pain.
Face livid, and covered with cold perspiration ; pulse
110 per minute and feeble ; paraplegia had supervened
when brought to the hospital.
TEEATMENT.
Same treatment was followed for one hour ; pulse 94
per minute and a little stronger ; continued the beef tea
every half hour with rest for two hours longer, when
the pulse was 88 per minute and the paraplegia par-
tially subsided, although he still complained of shooting
pains in both legs ; kept him all night at the hospital.
The following morning his pulse was 84 per minute; the
paraplegia had subsided ; could move his legs ; still felt
weak, but was able to go home.
At the East pier, on April 13th, about 5 o'clock a. m.,
a break happened in the coffer-dam, above the caisson,
and was (;aused by the rise of water in the river, the
water rushing in the main or central shaft leading to
69
the air-lock and air-cliainbers ; the work was interrupted
and all the men working therein were transferred to the
West pier, where the men were not yet under our care
for prophylactic treatment, and were still working three
watches of two hours each, making six hours work
every twenty -four hours.
A number of cases happened at the West pier, where
up to April 15th, no reduction in the duration of time of
work had been made ; it being supposed that the pres-
sure being less, the men working in the air-chambers
were able to stand it better.
But we were of a different opinion, having had some
very serious cases from the West pier, and we sug-
gested a reduction of the time of work from two hours
three times a day to two hours twice a day, with
four hours rest between each two hours work. Not-
withstanding this change, some men were taken sick
after working one or two watches only in the air-cham-
bers, but we must say that those men had not been
examined hy us hefore Gommencing to worTc, and not-
witTistanding the positive directions and orders which
had been given not to allow any new man to go to
work in the air-chambers without being examined by
the physician, and to be declared in a fit condition
for such work.
To avoid useless repetitions hereafter, loe will he as
trief as possible in epitomising the following cases,
and will give details only, when we think a case
requires it.
CASE XXI.— Apbil 14th.
West Pier. Barometer 29° 60'. Thermometer 80°.
Weather clear. Pressure 40 pounds to the square inch.
F. Taebeaux, 35 years ; nativity. United States ; had
worked three weeks, and suffered twice before of pains
in both legs ; but after resting a day or so he recovered,
and went to work again. This time he was taken sick
immediately after coming up.
70
SYMPTOMS.
Epigastric pain and parapsis of both legs immedi-
ately after coming up ; pulse 98 per minute and
feeble.
TREATMENT.
Similar as in other cases was followed, and after
six hours his pulse was 80 per minute and good ; the
parapsis had subsided, and he was able to be sent
home. After resting four days he returned to work.
CASE XXII.— Apeil 14th.
West pier. Barometer 29° 60'. Thermometer 80°.
Weather clear. Pressure forty pounds to the square
inch.
August Millee, 25 years ; nativity, Germany ; had
worked only two hours in the air-chambers ; was taken
sick after the second watch, and immediately after
coming up ; of medium stature, slenderly built.
SYMPTOMS.
Complained of epigastric pain and parapsis of both
legs ; pulse 100 per minute.
TREATMENT.
The same treatment was followed as in similar cases,
and after six hours he felt better ; pulse 88 per minute ;
kept all night at the floating hospital ; following morn-
ing pulse 82 per minute ; parapsis subsided ; felt well
but weak and was able to go home.
CASE XXIII.— Apeil 16th.
West pier. Barometer 29° 70'. ' Thermometer 43°.
Weather cloudy. Pressure forty pounds to the square
inch.
August Tompkins, 30 years ; nativity, United States ;
worked two months ; had sufterod once of pain in botli
legs ; this time he was taken sick after the last watch,
20 minutes after coming up ; tall and slenderly built.
71
SYMPTOMS.
Yiolent epigastric pain, and parapsis of both legs ;
face livid ; pulse 68 per minute.
TREATMENT.
Same as in similar cases ; after six hours rest felt
better ; pulse 76 per minute and stronger ; is sent home,
April 17. — Felt well, but weak ; pulse 78 per minute ;
parapsis of both legs disappeared.
April 18th. — Still stronger ; pulse 80 per minute.
After examination finding him unfit to return to work
in the air-chambers, he was forbidden to go in any more.
CASE XXIV.— Apeil 18th.
West Pier. Barometer 29° 70'. Thermometer 58°.
Weather clear. Pressure 40 pounds to the square inch.
August J^iedeemetee, 20 years ; nativity, Ger-
many ; was taken sick after the second watch of two
hours which he had worked in the caissons ; went to
work with a friend, and, notwithstanding the orders,
was not examined before ; was taken sick immediately
after coming up, and brought to the hospital in an
insensible condition ; patient of medium stature, but
very slenderly built.
SYMPTOMS.
Face livid, pulse 110 per minute, and paresis of
both legs.
teeatmeft.
Same as before followed for one hour, after which
the pulse was 94 per minute ; continued the same for
three hours longer, when the pulse was 89 ; kept him
all night at the floating hospital, and on the following
(19th) at 7 o'clock a.m., pulse 84 per minute ; the
paresis had subsided, but ;^he felt weak; sent him
home, with injunction not to return in the air-cham-
bers ; but notwithstanding which, he did, two days
after, and was retaken with the same symptoms
72
after the first watcli. The same treatment was fol-
lowed, and he recovered, but was for a month very
feeble.
CASE XXV.— Apbil 18th,
West Pier. Barometer 29° 70'. Thermometer 58°.
Weather clear. Pressure 40 pounds to the square inch.
James W. G-allowat (foreman), 29 years; nativity,
United States; worked two months and twenty days;
had suflered before of pains in both legs, but after
a day's rest returned to work. This time he was taken
sick after the last watch, about . half an hour after
coming up, and immediately after reaching home.
The patient is of medium stature, and well built.
SYMPTOMS.
Complained of violent epigastric pain, and as soon
as taken sick, paraplegia also had supervened; pulse
64 per minute ; he had not urinated for six hours, and
retention of urine existed — the bladder being very
much distended. Catheterism was used, and drew
three pints of highly-colored but clear urine.
TREATMENT.
Same as in similar cases.
April 19th, 8 a.m. — Found the patient restless ; pulse
85 per minute ; had been obliged to use the catheter
himself during the night; suffering from great dis-
tension of the bladder, from which he drew the same
quantity of urine as before ; the paraplegia still ex-
isted, and the catheterism was used every eight hours.
April 20th. — Pulse 90 per minute ; had been restless
until he had two involuntary stools in the night, but
did not urinate, and the bladder being full, he had to
cathe cerise himself. There being no prospect of im-
mediate improvement in his case, the patient desired
to be removed to St. Luke's Hospital, to remain under
my care.
73
April 21st — Patient removed to tlie hospital, and
is better ; pnlse 85 per minute ; paraplegia lias par-
tially subsided; was able to move bis legs a little,
but still obliged to use tbe catheter every eight hours
— the bladder, when distended, causing such pain that
it was impossible for him to endure it any longer.
April 22d. — Same.
April 23d and 24th. — Same.
April 25th. — Better ; pulse 80 per minute ; appetite
good ; slept well, but obliged to catheterise himself
every six hours.
April 26th, 27th, and 28th.— Same.
April 29th. — Had a chill last night, which was fol-
lowed by strong fever, and ceased only in the morning ;
pulse 92 per minute and full ; tongue very coated and
dry; towards evening, when he catheterised himself,
some pus was detected in the urine.
April 30th. — Same ; pulse 95 per minute ; more pus
in the urine, which was very foetide, and became am-
moniacal very quick.
May 1st. — From this day the patient showed similar
symptoms, and his case took the same course as case
Vn. The same treatment was then followed until the
31st of the same month, at which time he had nearly
recovered; his pulse was 80 per minute, his appetite
good, slept well, urinated freely, bowels regular, and
he commenced to gain flesh ; contemplated returning
to his home in Indiana in a few days. From the 1st
June to the 8th, he took gradual out-door exercise
every day.
June 9th and 10th. — Feeling well and strong ; on the
11th left for home, recovered.
July 30th. — Had news from him, when he was in
good health and strong.
74
CASE XXVI.— Apkel 19th.
West pier. Barometer 29° 65'. Thermometer 62°.
Weather cloudy. Pressure 40 pounds to the square
inch.
Mike McCoole, 29 years ; nativity, Ireland ; had
worked three weeks ; was taken sick after the first
watch, commencing at 5 o'clock a.m. and ending at 7
o'clock A.M. ; had not taken any breakfast before going
to work ; was taken sick immediately after coming
up, and was in a syncopal condition when brought to
the hospital. Of small stature, but well built.
SYMPTOMS.
Face very pale ; pulse 110 per minute and feeble ;
parapsis had supervened when brought to the hospital.
TEEATMENT.
The treatment followed was the same as in similar
cases, and one hour after his pulse was 90 per minute,
and stronger. Continued the same treatment for two
hours longer, after which his pulse was 85 per minute,
and the parapsis had disappeared. Kept him at the
iloating hospital until evening, when his pulse was 82
per minute and good, and he felt well enough to go
home, intending to rest a few days.
April 21st. — Felt well, and expected to return to
work, if allowed.
CASE XXVII.— Apeil 19th.
West pier. Barometer 29° 65'. Thermometer 62°.
Weather cloudy. Pressure 40 pounds to the square
inch.
P. Johnson, 24 years ; nativity, United States ; had
worked one week ; was taken sick after the last watch,
immediately after coining up. He is tall, and slenderly
built.
SYMPTOMS.
Face livid, and covered with profuse perspiration ;
pulse 110 per minute and feeble ; complained of epi-
gastric pain, and had a syncope when brought to the
hosijital.
75
TEEATMEISTT.
Same was followed as in similar cases for one hour,
after wMcli the pulse was 94 per minute ; same treat-
ment continued for two hours longer, when the patient
felt much better, pulse heing 85, and stronger ; still
feeling very weak ; kept him all night at the floating
hospital, and the following morning, April 20th, he felt
much better ; pulse 82 per minute ; slept well, and was
well enough to go home by himself.
CASE XXVIII.— Apbil 22d.
West Pier. Barometer 29° 65^ Thermometer 77°.
Weather clear. Pressure 40 pounds to the square inch.
Alfreist Koenee, 19 years ; nativity, Germany ; has
worked three weeks ; taken sick after the last watch,
and immediately after coming up ; of tall and slender
build. This case was similar to case XXVII., and the
treatment followed was the same. After eight hours
rest he was able to go home by himself.
CASE XXIX.— Apeil 24th.
West Pier. Barometer 29° 65'. Thermometer 72°.
Weather cloudy. Pressure 40 pounds to the square
inch.
Pateick Feelais", 22 years ; nativity, Ireland ; worked
two weeks in the air-chambers ; was taken sick after
the last watch, immediately after coming up ; of
medium stature, slenderly built. This case was simi-
lar to case XXVn. TTie same treatment was followed
with the same result. He was kept at the floating
hospital all night, and went home well the following
morning.
CASE XXX.— Apeil 25th.
West Pier. Barometer 29° 88'. Thermometer 67°.
Weather cloudy. Pressure 40 pounds to the square
inch.
RoBEET Allef, 29 years ; nativity, Ireland ; worked
three weeks ; was taken sick after the last watch, about
76
twenty mimites after coming up ; patient of medium
stature, and well built.
SYMPTOMS.
Face was livid and covered with profuse perspiration ;
pulse 64 ''per minute ; complained of violent epigastric
pain, and paresis had supervened in both legs.
THE TEEATMENT
Used in similar cases was followed for one hour, when
the pulse was 70 per minute, and after two hours longer
was 74 per minute ; kept him all night at the floating
hospital, and saw him on the following morning, April
26th, at 8 o'clock a.m., when his pulse was 76 per
minute, and the paresis had ceased ; feels well, but
weak ; desired to go home, and left accordingly.
CASE XXXI.— Apbil 25th.
West Pier. Barometer 29° 88'. Thermometer 67°.
Weather cloudy. Pressure 40 pounds to the square
inch.
Antony Patochy, 32 years ; nativitj^, Germany ;
worked nine days ; was taken sick after the last
watch, immediately after coming up ; tall, and of
slender build. This case was similar to case XXYII.
TTie treatment followed was also the same, and eight
hours after, he was able to^go home without assistance.
CASE XXXII.— Apeil 25th.
West Pier. Barometer 29° 88'. Thermometer 67°.
Weather cloudy. Pressure 40 pounds to the square
inch.
John KeaeneiT, 24 years ; nativity, Ireland ; had
worked two months and twenty days ; was taken sick
after the last watch, half an hour after coming up,
and immediately after reaching home ; above medium
stature, and well built. His case was similar to case
XXVII. TJie treatment was the same. He recovered
and was well, enough to recommence work after a
week.
77
CASE XXXIII.— Apbil 28th.
"West pier. Barometer 29° 67'. Thermometer 54°.
Weather cloudy. Pressure thirty-eight pounds to the
square inch.
Petee Peteesoist, twenty-four years ; nativity, United
States; worked four months; was taken sick after the
last watch, and immediately after coming up ; of medium
stature and well built.
This case was similar to case XXII, and was treated
accordingly. After eight hours rest he was permitted to
go home. -
CASE XXXIV.— Apbil 28th.
West Pier. Barometer 29° 67'. Thermometer 54°.
Weather cloudy. Pressure thirty-six pounds to the
square inch.
Aecom, twenty-one years ; nativity, G-ermany ;
worked two and one half months ; was taken sick after
the last watch, and immediately after coming up ; of
medium stature and well built.
This case was similar to case XXYII., rather more
severe ; treatment similar ; was kept all night at the
floating hospital, and on the following morning was
able to go home.
On the twenty-third of April it was found that the
air-pumps forcing the compressed air into the air-cham-
bers, instead of being cold were becoming heated for
want of a sufficient supply of cold water in the boxes
attached to them. During two days, the tempera-
ture in the air-chambers, which previously averaged
fifty (50) degrees, increased to sixty (60), and on the
25th rose to sixty-eight (68), but by keeping the air-
pumps cool the temperature did not exceed sixty-
six (66) degrees. The compressed air, after passing
through the equalising valve from the air-chambers
into the air-lock, increased its temperature by the
Dl
78
friction through it. The consequence was that the tem-
perature in the air-lock increased from 15 to 18 de-
grees above the temjperature in the air-chambers, while
the working men were in the air-lock and passing
from the normal atmosphere into the air-chamhers.
Another cause of the still further increase of the
temperature was the heat produced by the tem^porary
stay of the workmen {ten in number) in so small a
space as was the air-lock, it having only one hundred
and sixty-two (162) cubic feet capacity for all {ten
men being the average number) going into it at the
same time, allowing only a very small fraction o'oer
sixteen (16) cubic feet for each man. This explains
why the temperature increased so much during their
stay in the air-lock whilst going to work in the air-
chambers.
In order to prevent further increase of the temperature
in the air-lock, it was directed that a wooden box be
made to fit closely the side of the wall of the air-lock in
the air-chamber, and where the opening of the equali-
zing valve into the air-lock was situated, the box to
contain fifty pounds of ice broken into pieces the size of
a man's fist ; the side of the box opposite the one next
to the wall of the air-lock, bored with about thirty holes
of one-eight of an inch in diameter, through which the
greatest part of the compressed air, before escaping
through the equalizing valve had to pass, as also through
the ice in the box, which was to be kept constantly full
while the men were working in the air-chambers. The
compressed air, consequently, being cooled before enter-
ing the air-lock, prevented the temperature increasing
above 68° while the men were in the air-lock or going
to work in the air-chambers, thus avoiding, as far as
possible, the pathological eifects which certainly would
have been caused by the high temperature and increased
atmospheric pressure of thirty -five (85) pounds to the
square inch.
79
So far, we had obtained some success by tlie prophy-
lactic means used, as also by the treatment followed in
the numerous cases which occurred, since we commenced
our professional attendance at the bridge. Still we
were not satisfied with the results obtained. From
repeated observations, believing that exhaustion caused
by an excess of waste on the bodies of those working in
the air-chambers — waste, which, going on by their re-
peated exposure in an over-condensed atmosphere was
one of the principal causes of the frequency of cases.
In order to ascertain this, we thought, that if there was
an extra waste on the system of the men working in the
air-chambers it would manifest itself under the form and
by an excess of urea, to be eliminated by the kidneys
during the secretions of urine, besides the quantity of
urea not accounted for and contained in the profuse
perspiration with which the men were constantly cov-
ered when working in the air-chambers.
We then proceeded to make examination of the
urine of healthy men who had worked, and were still
working, in the air-chambers, with the following results :
80
The examinations were made on the urine of thirty-
two men on the 28th and 30th of April, and imme-
diately after the men came out of fhe air-cTiamhers^
and before tJiey liad talcen tJieir dinner, or any food or
spirituous drinlc for at least seven hours, and had
urinated at least twice during that time.
The examinations were also made on the urine of four
sick men, drawn at the second time the catheter was
used, and about eighteen hours after they were taken
sick.
Had worked in
Spec.
Chemical
Mo.
Names.
Age.
the air-chambers.
Gra'y
Reaction.
Kemarks.
1
R. Colgan
38
3 months
1025
Neutral.
2
Mike McGoole ....
24
3 weeks
1029
"
Taken sick case 26.
3
George Hetzel
25
3mths Iweek..
1023
a
4
Thomas Morris . . .
28
3 mthsl week. .
1028
('
Taken sick case 39.
5
John Dering
23
3mths 1 week. .
1023
(C
Taken sick case 47.
fi
Stenson
25
17
15 days
7^ weeks
1018
1028
7
W. Dudley
Taken sick case 37.
8
Thomas Connelly.
39
5 months
1026
ii
9
WilUam Welsh....
24
3 months
1028
Alkaline.
Taken sick case 43.
10
August Donkey. . .
36
3 months
1027
Neutral.
11
August Meyer ....
30
5 months
1026
ct
VA
James Cham
45
5 months
1025
Alkaline.
13
T. R. Tafiey
25
3 months
1023
Neutral.
14
Walter Sawer
20
5 months
1030
«'
15
John Oonroy
23
1 month
1025
"
16
Patrick Ford
22
5 months
1025
"
17
O'Keelfe, Foreman
26
4ck months
1020
"
18
M. McDermot
25
3A months
1020
"
19
A. Wimer
30
2 months
1020
"
20
W. Ho2;an
42
3 months
1022
"
21
T. Kelgey
36
5 weeks
1032
"
Taken sick case 9.
W,
DoneUy
3?,
4^ months
1029
"
Taken sick case 36.
23
G. Clency
20
2 months
1028
"
24
W. Burns
19
3 months
1026
"
25
VA. Green
35
IJ months
1030
"
Taken sick case 42.
26
L. G. Thompson. .
29
4 months
1027
"
27
Mike Herwin
24
3 months
1029
a
Taken sick case 40.
^8
TiOfiTnis , . . . ,
27
40
44
\h months
4| months
4| months
1033
1033
1030
<(
9Pi
Tucker
30
Brown, Foreman . .
31
G. Murphy
17
3 months
1030
"
32
P. Reynolds '.
24
IJ months
1025
k(
The urine of the four sick men was as follows :
Ansop Miller . . . .
Lyons, Foreman,
J. W. Galloway..
Louis Boyer
7 weeks
4^ months
21011118 3 weeks
6 hours
1030
1035
1035
1030
Neutral.
Alkaline.
Case 12.
Case 2.
Case 15.
Case 7.
By the above statement it will be seen that, excepting
81
six, the quantity of nrea found was greater than in
healthy urine of men working in the open air, and
which specific gravity is from 1010 to 1020, whereas
among the cases ahove enumerated, the specific gravity
of urine was over 1023, notwithstanding its dilution, as
the men were drinking water freely, and among those
taken sick the quantity of urine, so far from being less,
had increased.
Notwithstanding all the vigilance and care taken to
prevent the recurrence of cases, no satisfactory results
were obtained until the following rules were strictly
enforced :
1st. The time of work was reduced to two watches,
instead of three ; and as the work of filling up the air-
chambers progressed — the space becoming smaller — the
number of workmen was gradually decreased, and the
time of work in each watch was reduced to one hour,
instead of two, and with three hours rest between each.
2d. The men were not allowed to go ashore from the
time they commenced their day's work. They had
also to take their dinner with them, to prevent any
excuse for leaving the piers ; and if a man absented
himself, even for one dsij, he had to be re-examined by
the physician before returning into the air-chambers.
3d. The men, when coming up from work, were com-
pelled to remain quiet, or lie down, for at least half an
hour ; and when taking their dinner, by my direction,
each man was provided with three quarters of a pint of
beef tea, which was made with Liebig's extract of meat,
in the proportion of six ounces of extract to a gallon of
boiling water. The same was also subsequently given
to the men working in the air-chambers at the east
pier, after they recommenced work.
TJiese rules loere enforced from tlie ^StJi April until
tTie StTi May, loTien the filling up of the air cJiamhers
at the west pier caisson was completed, and no more
cases happened during the last ten days.
82
After the filling up of tlie air-chambers at the west
pier was completed, the men were allowed a few days
rest, until they should recommence the same work,
which had been interrupted at the east pier by the
breaking of the coffer-dam over the caisson.
The work of filling up the air-chambers with concrete
was recommenced at the east pier on the 11th Ma^y.
The duration of time of work was directed to be thiee
hours per day, divided into three watches of one hour
each, with three hours rest between each watch.
N'otwithstanding all the care taken, we must say that
on the first day the work recommenced — it heing im-
possible then to enforce tlie rules wMcTi Tiad been
adopted for the west pier — some of the men came
without their dinner; and among those who com-
menced to work that day one fatal case occurred, but
which really ought not to be taken into account among
the number of cases, it being the result of the im-
prudence on the part of the sufferer, and which is
case XXXy.
CASE XXXV.— Mat 11th.
East Pier. Barometer 29° 68'. Thermometer QQ°.
Weather cloudy. Pressure 49 pounds to the square
inch.
William Saylee, 30 years ; nativity, Germany ; of
medium stature, and well built ; worked three months
in the west pier, where the pressure was for two weeks
40 pounds to the square inch, from which he suffered
no inconvenience.
He worked from 8 to 9 o'clock A. m. and felt well after
coming up. He had not brought his dinner with him,
and at half past 11 he went ashore, he said, to take his
dinner, which he did not do, but drank without eating
anything, as will be proved hereafter. He returned
shortly before 1 o'clock, p. m., his watch being from 1 to
2 o'clock, and resumed work.
After Ms watch was otier, and immediately after
leaving the air-lock^ and while ascending the stairs in
the shaft, he was taken sick, had to "be carried up, and
became insensible while being carried to the hospital,
where I saw him a few minutes after. He remained
insensible until 4.20 p. m., when he died.
Post mortem examination was held sixteen hours after
death, and which elicited the following facts :
Cranium. All the blood vessels of the scalp, as also
all the membranes covering the brain, were highly con-
gested, and about two ounces of serum escaped from the
vertebral canal when the brain was removed. The
brain was congested and two ounces of serum found in
the ventricles.
The Heart was of normal size; the right ventricle,
as also the left, were normal. The lungs were inflated
and of normal appearance, but there were large adher-
ences around the base of the right, and which seemed
to be of long standing. The liver was normal as well as
the spleen. The kidneys were normal, as was also the
bladder, but empty. The stomach normal and entirely
empty ; no traces of 'food were found, which confirmed
my opinion that this man had not taken any dinner,
and probably a very light breakfast, but had been
drinking quite freely, as it was afterwards ascertained.
We must say, moreover, that the gang with which
this man had been working in the air-chambers, after
quitting work, and while in the air-lock on their return
into the normal atmosphere, allowed the compressed air
to escape too freely, so that the equalization of pressure
with the open air tooli place too rapidly, and by remaining
less than four (4) minutes in the air-lock, whereas the
time necessary for the gradual equalizing of pressure
with the normal atmosphere ought to have been eight
and one half (8J) minutes.
84 .
On tlie 12tli of May, the same regulations adopted at
the West pier were enforced, and it will be seen, that
notwithstanding the increase of pressure to which the
men were exposed in the air-chamlbers, the number of
cases was not only greatly diminished, but they were of
^ a less serious character.
CASE XXXVI.— Mat 12th.
East Pier. Barometer 29° 70'. Thermometer 62°.
Weather cloudy. Pressure 40 pounds to the square
inch.
DoNELLT, (foremen,) 32 years ; nativity, Ireland , had
worked four months ; had suffered from epigastric pains
before, but recovered after a few days rest, and then
returned to work. At this date he was taken sick after
the second watch.
His case was similar to XXYII. The same treatment
was followed ; he recovered, but was forbidden to return
to the air-chambers, and was given work elsewhere.
CASE XXXVII.— May 12th,
East Pier. Barometer 29° 70'. Thermometer 62°.
Weather cloudy. Pressure 49 pounds to the square
inch.
W. Dudley, 17 years ; nativity. United States ;
tall and slender build ; worked two months and a
half; taken sick after the second watch, immediately
after coming up. This case was similar to case XXVII.
but less severe. The same treatment was followed,
and after eight hours rest, he was able to return home.
CASE XXXVIII.— May 12th.
East Pier. Barometer 29° 70'. Thermometer 62°.
Weather cloudy. Pressure 49 pounds to the square
inch.
James Jennings, 30 years ; nativity. United States ;
of medium stature, and well built ; worked two months ;
taken sick after the second watch. This case was
85
similar to case XXYII., bnt less serious. Tlie same
treatment was followed, and after six liours he went
home.
CASE XXXIX.— May 12th.
East pier. Barometer 29° 70'. Thermometer 62°.
Weather cloudy. Pressure 49 pounds to the square
inch.
Thomas Moekis, 28 years ; nativity, Ireland ; of
medium stature, and well built; worked three months
and three weeks ; taken sick after the second watch,
about twenty minutes after coming up. This case was
similar to case XXX., but less serious- The same
treatment was followed, and after twelve hours rest
he was able to go home.
CASE XL.— May Mth.
East Pier. Barometer 29° 80'. Thermometer 70°.
Weather clear. Pressure 50 pounds to the square inch.
Michael Heewik, 24 years ; nativity, Ireland ; of
medium size, and well built ; has worked three months
and a half ; was taken sick after the last watch, half an
hour after coming up, and immediately on reaching
home ; saw him half an hour after, and observed a
difference in the symptoms from other cases.
SYMPTOMS.
The face was flushed; pupils contracted; the skin
hot ; pulse 110 per minute, but moderate. The patient
complained of parapsis of both legs, and of shooting
pains in the chest. A few minutes before I came, he
had spat some blood, and did the same during my visit.
The blood was very red, and the total quantity was
about three ounces. The auscultation revealed crepita-
tation at the anterior and middle part of the right lung.
The tongue was slightly coated, and he had had no
evacuation from the bowels for two days.
86
TEEATMENT.
I prescribed one enema with two fluid draclims of
tincture of assafoetida and two pints of tepid water,
wMch, after administration, produced two large evacu-
ations ; he afterwards slept a little.
May 15th, 8 o'clock a.m. — Pulse 90 per minute and
soft ; feeling much better ; the parapsis of both legs
had subsided ; had spitted blood twice in the night ;
he asked to be removed to the St. Luke's Hospital, to
remain under my care.
May 16th. — Eemoved to the hospital ; had some fever
last night, but is better this morning, and spits no more
blood.
May 17th. — Same ; pulse 88 per minute ; skin moist.
May 18th.— Same.
May 19th. — Commenced to cough and expectorate ;
the sputum is semi-purulent, with a slight tinge of
blood ; pulse 86 per minute ; the auscultation reveals
the same crepitation on the right lung ; felt better,
with some appetite.
May 20th, 21st, 22d. — Same ; pulse 82 per minute ;
skin good ; bowels regular ; expectoration continues, but
without blood.
May 23d, 24th, 25th.— Same.
May 26th, 27th. — The expectoration ceased ; very little
crepitation existed in the right lung ; pulse 82 per min-
ute ; felt well, and left the hospital on the following day.
CARE XLI.— Mat 15th.
East pier. Barometer 29° 78'. Thermometer 80°.
Weather clear. Pressure 48 pounds to the square inch.
John Wood, 24 years ; nativity, England ; of medium
stature and well built ; worked two and one half months.
This case was similar to case XXVII, but less severe.
The treatment followed was the same, and after six
hours rest went home.
87
CASE XLII.— May 15th.
East Pier. Barometer 39° 78'. Thermometer 80°.
Weather clear. Pressure 48 pounds to the square inch.
Edwaed Geeen, 35 years ; nativity, Ireland ; tall and
slenderly built ; worked two months ; had previously
suffered with parapsis of both legs, from which he
recovered ; and, after a few days' rest, returned to work.
This time he was taken sick after the second watch, and
immediately after coming up. This case was similar to
case XX"VII. The treatment was also the same, and
after eight hours rest he went home. In a few days he
returned to work ; was retaken with the same symptoms
after the second watch. The same treatment was again
resorted to ; he recovered a second time, but before
returning home he was discharged from further work in
the air-chambers.
CASE XLIII.— May 16th.
East Pier. Barometer 29° 75'. Thermometer 83°.
Weather clear. Pressure 47 pounds to the square inch.
William Welsh, 21 years ; nativity, Ireland ; above
medium height and well built ; worked four months ;
was taken sick after the last watch, about twenty-five
minutes after coming up, and while on board the boat
crossing the river to the shore. He was taken home,
where I saw him a few minutes after. This case was
similar to case XXX but less severe. TTie same treat-
ment was followed, and on the following morning he
was much better, but very weak. He was advised not
to return to the same work.
CASE XLIV.— May 16th.
East Pier. Barometer 29° 75'. Thermometer 83°.
Weather clear. Pressure 47 pounds to the square inch.
John Mueeat, 19 years ; nativity. United States ;
above medium stature and well built ; worked four
months ; was taken sick after the last watch. Similar
to case XXYII, The same treatment was pursued, and
on the following morning he was well, but quite weak.
E
88
CASE XLV.— Mat 15th.
East Pier. Barometer 29° 75'. Thermometer 82°.
Weather clear. Pressure 47 pounds to the square inch.
M. O'Keefe, 35 years; nativity, Ireland; medium
stature and well built ; has worked four and one half
months ; taken sick after the last watch, and about
twenty minutes after coming up. This case was similar
to case XXX but less severe. The treatment followed
was the same ; he recovered, but was weak for five oy
six days.
CASE XLVI.— Mat 16th.
East Pier. Barometer 29° 79'. Thermometer 82°.
Weather clear. Pressure 47 pounds to the square inch.
Stephens Hejstry, 22 years ; nativity. United States ;
medium size, and well built ; worked four months ; was
taken sick after the second watch. This case was
similar to case XXX, but less severe. Ttie same treat-
ment was followed, and after eight hours rest the
patient was allowed to return home.
CASE XLYII.— Mat 218T.
East Pier. Barometer 29° 80'. Thermometer 48°.
Weather clear. Pressure 47 pounds to the square inch.
Steven Deeing, 23 years ; nativity, Ireland ; above
medium stature, and well built; worked four months
and a half ; was taken sick after the second watch, 11
o'clock A.M. This case was similar to case XXX, but
less severe. Tlie same treatment was followed, and
after remaining in the floating hospital until the next
morning, he was better, but weak, and went home.
CASE XLVIII.— May 22d.
East Pier. Barometer 29° 74'. Thermometer 80°.
Weather clear. Pressure 47 pounds to the square inch.
James Howard, 23 years ; nativity, United States ;
medium height, and well built; worked one month
and a half; taken sick after the second watch at 12
o'clock, M. This case was similar to case XXX, but less
severe. The same treatment was followed, and on the
following day he was much better, but weak.
CASE XLIX.— May 27th.
East Pier. Barometer 29° 70'. Thermometer 75°.
Weather clear. Pressure 45 pounds to the square inch.
H. Gr. Hakvey, 19 years ; nativity, England ; air-lock-
tender ; of small stature, but square built ; had worked
six months ; taken sick once before, on the 28th Feb-
ruary, and suffered then of parapsis, which subsided the
following day, and he returned to work after four days'
rest. This time he was taken sick after the second watch,
at 10 o'clock A.M. This case was similar to case XXX,
but less severe ; and after the treatment followed in
similar cases, and eight hours rest, he was well enough
to go home.
Besides these forty -nine cases we had under our care
at the east and west piers, there loill he found twenty-
eight other cases in Chapter XII., which occurred
during the sinking of the east abutment caisson, and
to which we will refer hereafter — these cases, for the
present, not properly helonging to the subject loe now
haTie under consideration.
CHAPTER yill.
PEOGEESS OF THE WOEK AFTEE EECOMMENCniTG AT THE
EAST PIEE — CHANGE OF THE ATMOSPHEEIC CONBITIOE"
EST THE AIE-LOCK AND AIE-CHAMBEES DUEING THE
FILLING UP WITH CONCEETE — CONSIDEEABLE INCEEASE
OF TEMPEEATUEE IN THE AIE-LOCK.
After having experienced the successive increase of
temperature in the air-chambers, as also a more consid-
erable increase in the air-lock, at the West pier, it was
supposed that at the East pier, where the pressure was
higher, the temperature would certainly increase in pro-
portion.
It was then deemed necessary to have the air forced
into the air-chambers by the force pumps, to pass
through several large coils of red copper pipes, the coils
five feet in diameter, and the pipes of the same diameter
as those of the air-pumps, the said coils equal in length
to 150 feet of pipes, and to be submerged in the river,
the temperature of which being lower than the atmos-
phere would cool the air before its entrance into the
air-chambers.
This was accordingly done, hut the coils not being
ready before the iWi of May, at noon, the increase of
temperature in the air-chambers, we think, caused
four cases to occur in the middle of the day, as will be
seen by the cases XXXVI, XXXVII, XXXVIII and
XXXIX. As soon as the compressed air passed through
the coils of pipes submerged in the river before entering
the air-chambers, then the temperature ceased to increase
above 66° in the air-chambers. After a few days the
space in the air-chambers becoming smaller, by the
filling up with concrete, the temperature increased again
91
by the constant mixing np of tlie hydraulic cement with
water, used to make the concrete, as, for illustration,
the slackening of fresh lime will do. Then the tem-
perature increased, notwithstanding ail the care taken
to prevent it, and during the remainder of the work
ranged from 6Q° to 72° in the air-chambers, as the state-
ment hereafter will exhibit.
But m the air-lock tlie temperature was considerably
more enery time tlie men Jiad to go from the normal
atmosphere through the air-locTc into the air-chamhers.
So much so, that on the 12th May, at 11 o'clock, a. m.,
the thermometer indicated 92°, and this at a pressure of
49 pounds to the square inch. An ice box, like the one
used at the West pier in the air-chambers, and in front
of the equalizing valve with the air-lock, was made, and
used immediately in the air-chambers, and continued
until near the completion of the work, and with the
following results :
We give herein a statement of the temperature in the
open air, in the air-chambers, and in the air-lock, when
going from the normal atmosphere into the air-chambers,
and since the 12th May, 4 o'clock p. m., until the 27th, at
noon, the day of the completion of the filling up of the
air-chambers at the East pier.
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During the last three days the temperature was
higher in the air-lock, the ice box being talien away,
there being no room for it ; but the successive, con-
stant, and alternative opening of both air-lock doors
partially supplied the difference for lowering the tem-
perature, the room, in the air-chambers becoming so
small that three or four men only were allowed to
worlc at a time, and not more than half an hour
each time, until the filling up of the air-chambers was
completed,
CHAPTER IX.
FREQUENT EXAMOTATIOlSrS, DURING THE TIME OF WORK,
OF THE MEK WORKING IN" THE AIR-CHAMBERS — AN
ALMOST CESSATION OF CASES.
The results obtained so far, since my attendance at
tlie bridge, if not entirely successful, had at least been
encouraging, and not to leave anything undone which
could be done to prevent the effects of compressed air
on the men working in the air-chambers.
As has been shown in the tabular statement, chapter
yill., from the 12th May the temperature in the air-
chambers being so much above the temperature which
existed before ; the pressure being 48 pounds to the
square inch, and the work progressing day and night,
the condition of the atmosphere in which the men had
to work, being changed by the increase of temperature^
suggested to me, the possibility of the appearance of
other symptoms, which had not been observed before
among the working men. Having always examined
the time taken by a gang of workmen when coming-
through the air-lock to return into the normal atmos-
phere, and that, notwithstanding my directions and
positive orders, not to come out too quickly, some-
times they took too sTiort a time to do it — that is
to say, if the pressure was 45 pounds to the square
inch, instead of remaining from seven to eight minutes
in the air-lock, to equalise the pressure with the open
air in the shaft, they remained only from three to four
minutes at the longest.
El
94
To prevent a further recurrence of this, I directed
that the equalizing valve between the air-lock and the
open atmosphere should be altered, — that is to say,
I had the area of the opening of said valve reduced,
which change had the desired result.
Since the recommencing of the work at the east pier,
besides the cases which are recorded in chapter YII.,
some of the men working in the air-chambers, a few
minutes after coming up, complained of the excessive
heat in the air-lock and air-chambers, and also of being
very tired ; many of them complained of headache,
principally on the frontal and temporal regions. Their
pulse was not over 90 per minute, but feeble ; the light
had more than its usual effect on their pupils, which
were in the majority of cases abnormally contracted,
those symptoms indicating, to a certain extent, a dispo-
sition to a certain form of meningitis.
We then considered necessary from the 14th of
May to examine the men more frequently, to prevent, if
possible, an increase of those symptoms. From that
day we examined every man, after coming up from the
air-chambers, regularly every six hours, day and night ;
and as soon as any one of them complained, we made
him rest one watch. In the most of cases all the
' symptoms disappeared, but in some they returned,
then we considered prudent to prevent such ones from
returning to the same work. We believe that by sys-
tematic examinations of the men every six hours, when
the work progressed, as also by the strict enforcement
of the rules already referred to, we obtained, as near as
possible for the present, all the results looked for ; and
we are able to say that from the 12th of May until the
27th, the day of the completion of the work in the air-
chambers, at the east pier, there were no more fatal
cases ; and if there were any others, they were less
severe, every one of them recovering rapidly, enabling
the patient to return to work within a few days.
CHAPTER X.
ANALYSIS OF THE PATHOLOGICAL EFFECTS AlsTD OF THEIE
CAUSES — EFFECTS OF COMPEESSED AIR OJST MAN AS A
LABORER IN THE AIR-CHAMBERS, AND ON MAN AS A
CASUAL VISITOR.
As we have seen, by olbservation of forty -nine cases in
chapter YII., the similarity of symptoms, varying only
in their intensity, the same treatment followed for all,
and the ultimate recovery of forty-five of them, oblige
us to differ as to the cause or causes which produced
such pathological effects ; and leads us not only to sup-
pose, but to affirm, that exhaustion of the system under
certain circumstances has been, with a very few excep-
tions, the cause of what have been called " bridge cases."
In support of our views on this theory of exhaustion,
as some may call it, we have to examine, first, the func-
tion of respiration. It is an admitted fact that oxygen
in excess in the normal atmosphere, has the effect to
increase the force and activity of the pulse, and that
the same atmosphere in which the excess of oxygen
exists, may be still respirable and support life ; pro-
vided, the proportion of oxygen will not exceed ten per
cent, above the normal quantity already existing in it ;
and that if a person is obliged to remain for a certain
length of time in an ambient atmosphere where oxygen
is in the proportion of ten per cent, in excess, we observe
that the respiration is increased in frequency.
It is admitted that the increase of respiration, or cir-
culation, produces an excess of waste on the system,
which, if long continued, exhausts it.
If then, such is the case, when a person is exposed
only to a surrounding atmosphere which contains no
more than ten per cent, in excess of oxygen above the
quantity in the normal atmosphere, what will be the
result on a man who is obliged to use great muscular
exertions, and to work in an amhient atmosphere con-
taining from three hundred and thirty Jive to four
hundred per cent, more oxygen than in the normal?
Let us, then, examine the condition in which the men
working in the air-chambers were placed.
The number of respirations for an adult in the normal
atmosphere, average eighteen per minute. The average
quantity of air introduced into the lungs of a medium-
sized healthy man, at each inspiration, is 115 cubic
inches, when breathing ; which gives for eighteen inspi-
rations per minute, 2076 cubic inches of air, and repre-
sents 477 48-100 cubic inches of oxygen. But, if we
now take into consideration the pressure under which
the men had to work in the air-chamberfe, which pressure
has 'been as high as fifty {^0) pounds to the square inch,
hut which we will only take at forty-five {4S) pounds to
the square inch, as a base for our calculation, we will
demonstrate the enormous difference in the proportion
of air which is inspirated into the lungs of the working-
men or visitors remaining in the air-chambers for a
certain length of time.
The pressure being forty -five (45) pounds to the square
inch, as we have said, instead of eighteen inspirations
per minute, they are increased to 21, and, instead of
2076 cubic inches Inspirated per minute there are °2^15,
representing 555 ^^ cubic inches of oxygen instead of
477 ^l But now, if we have to multi^jly this result by
four (4), being _^the number of atmospheres which was
the pressure in the air-chambers, then it will give 9660
cubic inches per minute, and the proportion of oxygen
will be 2221 ^ cubic inches coming hi contact with the
97
respiratory surface or wall of air-cells of tlie lungs
e'^bery minute^ instead of 477^^^wlien breathing in the
normal atmosphere.
^Notwithstanding the normal proportion in which the
oxygen exists with the other constituents of the normal
atmosphere, nevertheless, that same atmosphere being
condensed until the pressure is forty -fitie (45) pounds to
the square inch, the quantity of oxygen which we said,
was inspirated per minute instead of the quantity exist-
ing in the normal atmosphere.
It has been said " that the proportion of oxygen which
the red corpuscles of the hlood are capable of containing
are, to a certain degree, absolute, and do not depend
upon physical conditions, such as pressure.''^
This is true when the oxygen is in excess of its
proportional constituent in the normal atmosphere ; but
the function of respiration of the men working in the
air-chambers is taking place in an over condensed
atmosphere, and not only the same number of cubic
inches of surrounding compressed air in which they
are is inspirated by them, but even more, the number
of respirations being twenty-one (21) per minute, instead
of eighteen (18) in the normal atmosphere.
We believe that exposure over a certain length of
time to such an atmospheric pressure, is more than
sufficient to cause abnormal, if not pathological, effects
upon the men employed in the air-chambers.
Now, if we consider the excess of waste on the system
which is going on, and ought to be proportional to the
time that the men have to remain in the air-chambers ;
each time, being two hours duration, three times a day,
with an interval for rest of two hours only between each
time of work, we have the following results :
A healthy man breathes, when in the air-chambers
during two hours, at the rate of 2221^° cubic inches of
oxygen per minute, instead of 477''^ in the normal atmos-
phere ; the waste on his system will certainly be more in
proportion than in the normal atmosphere^ this propor-
tional waste heing caused hy the inspiration of com-
pressed air lohich contains no more oxygen than in the
proportion of the constituents of the normal atmosphere,
hut so much more in considering the "proportion of the
pressure existing in the air-chambers, as we liave sliown
above.
Suppose, for instance, that a man can stand tMs
change the first time he has been exposed to such
atmospheric pressure, and comes out of the air-chambers
feeling as well as when he went in, there is no doubt
that, notwithstanding his feeling well, the waste on his
system was going on, as we said. How long will it take
for that man to repair the waste made on his organism
by his sojourn of two hours in an atmosphere at the
pressure of forty-five (45) pounds to the square inch ?
From facts observed, we answer : for that man, besides
the time of rest allowed to men working in the normal
atmosphere, it will take a very small fraction less than
three hours and a half to recover only from the increased
waste by exposure in such a condensed atmosphere —
waste which has been going on at a quadruple rate com-
pared with the waste on a man working in the normal
atmosphere.
But, now, if, instead of a healthy man who has been
exposed for two hours in a condensed atmosphere, it is
a man whose health has been more or less impaired by
irregular habits or sickness, will it be safe for that man
to expose himself to the effects of the waste constantly
going on on his system, if he is obliged to return to work
after two hours rest only, and this repeated three times
during the day ? We think not.
The change on the healthy man, we may say more
properly, the loss of vitality or force of resistance caused
by the waste on his system, already impaired by return-
ing too soon to work in the air-chambers, that is to say
after two hours of rest only, and when he had not yet
0^
recovered from tMs waste, and returning to work once,
and even twice, on the same day in the same con-
densed atmosphere, and at each time more exhausted
'by worTc and exposure than when he commenced in
the morning. The chances for that man are, if he
persist in his work, and expose himself to the con-
tinual exhaustive power of the condensed atmosphere,
he certainly will be affected by it, and present the same
pathological symptoms that we have observed on the
forty-nine cases that we had under our care ; and far
more serious will be the effects on the man of impaired
health or delicate constitution.
There is no doubt that on the men working in the air-
chambers the waste on the system was increased in pro-
portion to the pressure existing in the air-chambers.
Have we not found on examination an excess of urea
in the urine of healthy men who had worked for some
time in the air-chambers ? We do not say that muscular
exertion is the cause of increase of urea, hut that re-
maining in an o'oer condensed atmosphere increases the
waste of the system, and which Is confirmed by the
increase of urea in their urine, collected at the time the
quantity of urea is admitted to he less. Moreover, they
have that profuse perspiration which always exists on
all the men while working in the air-chambers; and
does not nitrogen, a part of the waste of the tissues
escape through the skin by this profuse perspiration.
It maybe said that this profuse perspiration observed,
was not perspiration, but the condensation of the respi-
ration, or the condensation of the compressed atmos-
phere in which the men were working ; but this cannot
be, because the profuse perspiration covered every part
of the body, and even continued for some time after the
men had returned into the normal atmosphere.
As for the condensation of the condensed atmosphere,
this could not take place, the temperature of the body
being nearly 100°, and the surrounding atmosphere
100
only 48°, consequently lower, its condensation was im-
possible. This only demonstrates tliat it was perspi-
ration and very profuse too, wMch. continued, as we
have already said, for some time after the men returned
into the normal atmosphere, " hut not when returning
as quick as possible.''''
Is it then, surprising, that the secretion of the kidneys
was sometime interfered with, we mean among the most
serious cases reported before we took charge of the men.
This seems to us to be more than sufhcient to explain
the exhaustion which caused the symptoms observed on
the men taken sick who had worked in the air-chambers.
A cause to which we have already alluded in Chapter
yil, we think was a too long sojourn in the air-
chambers. From the first day of our professional
attendance at the bridge, we suggested that the time of
work in the air-chambers was too prolonged, and might
cause a compression continued beyond the vital resist-
ance of some of the liquids of the body, said liquids not-
withstanding their slight compressibility, are, according
to the laws of physics, nevertheless subject to the same
influence of increased atmospheric pressure, as is water
in its transformation from a liquid body to a gaseous one ;
(see our experiments on ebulition of water. Chapter II.)
and according to the laws of physiology, we may infer
that the circulation of the blood to the periphery of the
body having been interfered with, by the influence of in-
creased atmospheric pressure, while in the air-chambers,
and a great deal more from the periphery when return-
ing into the normal atmosphere by coming through
the air-lock " as rapidly as possible,''^ by allowing the
too rapid escape of the compressed air from the air-
lock, said interference of circulation manifested by the
early disintegration of tissues to the superflcie of the
body — disintegration extending sometimes to deep
seated organs, as the kidneys and bladder, as it was
found at the post mortem examinations.
101
But there are also other causes wMch. may predispose,
and even produce, on persons going into tlie air-cham-
bers as laborers, or, as visitors, all the symptoms and
effects already observed; and, we think it necessary^
nay, even important, to examine those causes. We
allude to the necessary time to remain in the air-lock
when going into the air-chambers and also when coming
out of them.
The proper time for the men to remain in the air-lock
when going into the air-chambers, as also when coming
out to return into the normal atmosphere, had been the
subject of different opinions, but proximate or specific
time to remain in the air-lock, had never been advised,
since the commencement of the work, until the time of
our observations and regular attendance at the bridge.
In anlaysing each theory or opinion, we looked for a
definite or proximate cause or causes of the symptoms
observed, as also for an indication of the duration of
time to remain in the air-lock when going in and out of
the air-chambers ; besides, there was no prophylactic
means advised for the workmen, nor any treatment
followed with satisfactory results, when some of the
men were taken sick at the piers, and to avoid, if possi-
ble, their removal to the hospital.
"We think, by reviewing each theory, we may be able
to give our reasons for differing in opinion, and we will
also indicate the duration of time necessary to remain in
the air-lock, when going in and out of the air-chambers ;
this duration of time not being an arbitrary one, hid
based in accordance with the amount of pressure exist-
ing in the air-chambers, and on facts which have come
under our observation, and confirm the correctness of
our views on the subject.
The first opinion given with which we differ, princi-
pally on account of its insufficiency, is as follows :
102
" That the affection hy which the laborers in the air-
" Ghanibers are attacked^ is chiejly attributed to the
" change from a Dery condensed to a comparati'Ge rare-
'''' fied atmosphere.''''
There is notMng definite in tMs opinion, even admit-
ting tliat tlie change from a condensed atmosphere to
the normal one is the cause, Ibut this is not a snfS.cient
explanation. How does it happen ? The writer quoted
above does not say whether the change was too sudden
or too slow ; or, if the duration of time to remain in the
air-lock was what it ought to have "been when the men
were coming out of the air-chambers ; and if it was Uot
possible to modify or improve the condition in which
the men were placed, and to avoid the pathological
symptoms observed as a consequence of this change.
The opinion of another writer was that the greatest
danger to persons entering the air-chambers is that
they enter too rapidly. If only they would admit the
pressure more moderately, so that the heart and in-
ternal organs could accommodate themselves to this
process of congestion.
We agree with this advice, but it is a very incomplete
direction to follow. There is no notice taken of the
amount of pressure existing in the air-chambers. He
says to admit the pressure more moderately, but there
is no duration of time even suggested. The amount of
pressure has from time to time varied considerably.
Supposing that this advice is followed, and that by
guessing at the time necessary to remain in the air-
lock, the pressure is admitted moderately but without
stating the duration of time, there may be a risk of
remaining in longer than it is safe ; and we ask, What
will be the effect on a person remaining too long a time
in the air-lock ? — For illustration, let us suppose
that the pressure is 45 pounds and the temperature is
65° in^ the air-chambers — according t© the explanation
we have before given (in Chap. IX.) the temperature
103
in the air-lock will increase to about 83° — may be
more — and maj reach even an equal temperature with
the one observed and related in chapter VII., which
increased to 92°.
Now, let ten men of medium stature — which is gene-
rally the number going at one time into the air-lock
—remain in the air-lock for a period of over fifteen
minutes ; we say over fifteen, because less will. not be
" moderately^'' ^fifteen minutes being a short time for
the pressure existing. Let them remain over this time,
to equalize the pressure with the air-chambers, which
is 45 pounds to the square inch, and take into consid-
eration the capacity of the air-lock, which is six feet
in diameter hy six feet in height, allowingto each man
only sixteen cubic feet to breathe in for over fifteen
minutes ; and *Ut the temperature which has never
been less than 7Ji.° and as high as 92°, lohen ten men
were in the air-lock and in which small space allotted
for those ten men, the carbonic acid evolved by the
respiration of each one, amounts to 191^* cubic inches
per minute, which being multiplied by ten amounts to
X^X^^'^ cubic inches, and multiplied by the number of
minutes— fifteen — gives a total of 28,776 cubic inches of
carbonic acid accumulated in this small space during
the time of their remaining in the air-lock, in which
a longer time might be attended with danger.
It was the condition in which those men were placed
which induced us to observe the variation of tempera-
ture in the air-lock conjointly with the existing pres-
sure ; and since the commencement of the filling up of
the air-chambers with concrete, we noticed its rapid
increase, which frequently ranged as high as 80° to 92°,
until the completion -of the work, on the 27th May,
1871.
It is therefore possible to foresee that the atmospheric
condition in which persons going into the air-chambers
104
may be placed by their remaining too long a time in
the air-lock, and that they would certainly run a
greater risk of being more affected, and principally
the laborers, who had to remain at work in the air-
chambers for two hours after entering them, and which
sojourn of two hours was in itself sufficient to predis-
pose to the symptoms we have observed and described
elsewhere.
We thought it was a capital point, and one not
to be overlooked, to ascertain, as near as possible,
the time necessary to remain in the air-look when going
into the air-chamhers ; and after repeated observations
and experiments, we gave the following directions, ac-
cording to the pressure and temperature.
We directed that no more than se^en persons at a
time, laborers or visitors, should enter the air-lock,
allowing them twenty-three (23) cubic feet each, instead
of sixteen, besides lessening the production of carbonic
acid evolved by respiration, and that the duration of
time for equalizing the pressure in the air-chambers,
should he one minute for every three pounds of pres-
sure, that is to say, if the pressure was thirty pounds,
ten minutes in the air-loek was necessary, and if forty-
fiiie pounds, fifteen Tninutes, and so on, maintaining
always the proportion of one minute to enery three
pounds, which time, when correctly, observed, was never
attended hy the slightest inconvenience among those
working in or visiting the air-chamhers.
Now, we have to examine the opinion of the same
gentleman as to the sojourn in the air-lock, when coming
out of the air-chambers, which direction, on the subject,
is very explicit, and is as follows :
" As to the manner of coming out of the air-lock, I
" should think it advisable to come out as rapidly as
''^ possible, for whether they suffer or not, there must take
105
'■'"place a certain degree of reaction to the surface of the
" body, which is only accomplished hy the remonal of the
" atmospheric pressure in entering the open air.''''
"Witli this opinion we differ mucli, not only as to the
time of duration to remain in the air-lock when coming
out of the air-chambers, but also as to the effects pro-
duced by this spontaneous change, advised " as rapidly
as possihW^ from a very condensed atmosphere to the
normal one, that we will for illustration take from our
observations on the 19th of February last, and when
the pressure was only thirty-seven and a half pounds to
the square inch.
Let us imagine a workman ready to go to work in the
air-chambers ; he is in good health, his complexion fair,
pulse 80 per minute. This man enters the air-lock and
remains in it twelve and a half minutes ; his pulse is
then 92, but as soon as he enters the air-chambers his
pulse, within fifteen minutes, falls to its normal standard,
and gradually becomes slower, as his sojourn is pro-
longed in the condensed atmosphere, so that after two
hours work in the air-chambers, we find that same man
with a pulse at 69 per minute. This pulse is evidently
an indication of depression of the system.
Now, this same man, in a depressed condition, leaves
the air-chambers, where the temperature is 45°, and,
notwithstanding this loio temperature he is cohered loith
profuse perspiration {such is the case with all the loorJc-
Qnen) and in entering the air-locTc he is directed " to come
out as rapidly as possi'ble^'' to return into the open air.
Now, it will be observed, that in six and a half minutes
— the time directed that this man had to remain in the
air-lock to equalize the pressure with the open air — the
thermometer had fallen to 32°, freezing point, this
being caused by the escape of the compressed air from
the air-lock in the normal atmosphere.
Now, if the time to remain in the air-lock is short-
ened, when coming out of the air-chambers, the escape
106
of the compressed air from the air-lock being still more
rapid, the temperature in the air-lock will decrease still
more rapidly, and be lower than ever before.
Is it advisable, not to saj safe, for any workingman,
already in an exhausted condition, sufficient to produce
all the symptoms heretofore observed, to expose himself
to more depressing causes, as we consider the freezing
atmospliere to he, as would he the case hy " coming out
as rapidly as possihle^^ which, instead of producing a
certain degree of reaction to the surface of the hody,
will prer^ent oil chances of reaction hy increasing still
more the want of mtalUy f
Is it not more rational and safe to make the change
from a highly condensed atmosphere to the normal one
more gradual, so that if there is to be a reaction to allow
it to take place in the open air, which, for persons
suffering from the effects of a too long sojourn in a
condensed atmosphere, is most favorable to them for
recovering from the phenomena which have been so
often observed ?
One last illustration in confirmation of the correctness
of our views.
Has not nearly every man working in the air-cham-
bers, when taken sick, after coming up from their work,
complained of epigastric pain, sometimes so violent as
to produce syncope ? If we look at those men loorlcing
in the air-chamhers when coming out and entering the
air-lock, they are covered with profuse perspiration ;
five out of six of them, have their chest and epigastrium
improtected for want of sufficient clothing. Is there no
danger then that the epigastrium, the liver, the spleen,
the diaphragm and the epiploon, tohich system of hlood
vessels are comyaratively more extended and numerous
than in any other part of the hody. Is there no danger
that the exposure of those organs to the influence of
cold, produced suddenly by the too rapid falling of the
temperature to freezing point in the air-lock, " hy coming
107
out as rapidly as possible,^^) will produce that very
same congestion that it is so important to avoid ?
We leave to every person conversant with, the subject,
to draw his own conclusion of our expressed opinions.
But it may be asked, how is it possible to explain how
it is that some are taken sick from twenty minutes or
more after coming up, and their pulse was always slow,
from 60 to 68 per minute, and that the pulse of those
taken sick immediately after coming up was from 95 to
115 per minute.
To this we will say, that those whose pulse was slow
had more endurance to resist exhaustion, and were not
yet in the same exhausted condition of those whose
pulse was as much as from 95 to 115 per minute, which
was the result of complete exhaustion caused by 'the
eflEbrts made in walking up tlie circular stairs in the
shaft to return to the surface of the piers, when
already in a more complete state of exhaustion on
leaving the air-chambers than those whose pulse was
slow after coming out.
We also call the attention of our readers to some
other supposed causes of the symptoms observed.
From the time the caissons touched^ the bed of the
river, it became necessary to use lights for the men to
work with in the air-chambers at the excavating of sand
and filling up with concrete. What is known as star
candles was used, as also coal oil lamps, but, notwith-
standing the condensed atmosphere in which the lights
were burning very freely, a large proportion of un-
burnt carbon escaped into the air-chambers, some of
which was inspirated by those exposed to it, and was
afterwards expectorated when they returned into the
open air.
Some time before we examined this fact, it was sup-
posed by many working in the caissons that this was
108
injurious to them ; but to this we had only to say that
it was not so, and that the unburnt carbon escaping
from the candles and lamps was, with a proportion of
oxygen existing in the condensed atmosphere in the
caissons under the influence of pressure, combining and
forming carbonic acid, which, as soon as formed, diffused
itself through the air-chambers, and was in so small a
quantity as to be harmless.
To some this explanation was sufficient, but it gave
rise to another theory, which was, tliat tlie amount of
carbonic acid tJius forined^ conjointly with the amount
which was e'Golved by the respiration of each man worTc-
ing in the air-chambers being considerable, that a part
remained in the system under the influence of tlie pres-
sure when in the air-chambers, and acted as poison.
The theory of the carbonic acid remaining in the
system, and to poison it, cannot hold good, for the
reason that in the air-chambers — the men perspiring
profusely — the carbonic acid found also its exit from
the system by the profuse perspiration. It is known
in physiology that it is a standard function of the
sMn to permit partial arterialisation of the blood,
atmospheric oxygen being exchanged for carbonic acid
through the sMn.
Now, instead of the atmospheric oxygen only, we
have a condensed atmosphere which contains four
times as much oxygen, it is then easily seen that the
the functions of the lungs not being impaired {as post
mortem examinations ha^e demonstrated) and perspira-
tion going on freely when the men were working in the
air-chambers, if the lungs were unable to remove all the
carbonic acid resulting from the waste of the body,
the surplus, if there was any, teas eliminated by the skin
during the time this perspiration was going on, and
which lasted as long as the men remained^ in the air-
chambers, but it was Dery important not to check it
too suddenly after the men were leaving their work
109
and when they were entering the air-lock to return
into the normal atmosphere, and {by " coming out as
rapidly as possible,'''') but to let that same perspira-
tion continue not only until, but after, the men had
returned into the normal atmosphere, and where, after
their return, keeping quiet a certain length of time,
then the lungs will perform what the skin ceases to
do, they will remove the surplus of carbonic acid from
the system, if there is any;' but this result can be
obtained only by remaining in the air-lock the time
we have indicated, and which is necessary in the
meantime to avoid the appearance of the patholo-
gical symptoms already observed. But we do not
believe that there was a sufficient quantity of carbonic
acid remaining in the system to produce any of the
pathological symptoms already observed, and more-
over, we will say we observed always that the respira-
tion was normal in every man we examined in the
air-chambers, and that each expiration was somewhat
deeper than when in the normal atmosphere, and that
there was no symptoms of asphyxia observed in any
of the cases, which fact was also proved wlien the post
mortem examinations were held. _,
This subject naturally led to the enquiry — What,
then, became of the carbonic acid, as there was none
found in appreciable quantity when we made our experi-
ments on the 19th February, 1870, nor after, until the
completion of the work ? To this we will say that the
carbonic acid evolved by the respiration of the working
men and visitors in the air-chambers, as also from the
combination of the unburnt carbon of the candles and
lamps with oxygen, or formed from any other causes,
that the said carbonic acid thus formed or evolved was
diffused through the condensed atmosphere in the air-
chambers, and that the condensed air, in which was
diffused the carbonic acid, loas constantly escaping
under the edge of the caissons through the sand into
-el
no
tlie riTier, as also hy the frequent opening of fhe^doors
of the air-lock^ loMch was constantly used for ingress
and egress purposes in and from the air-charribers^
tlieii allowing to escape its contents of compressed at-
mosphere at each. time, which was replaced by a con-
stant supply of pure compressed air by the air .pumps
working day and night. Hence it was that the quan-
tity of carbonic acid was unappreciable by the ordinary
test, in consequence of its small quantity and extreme
diffusion ; and, consequently, could not have any in-
jurious effect on the men working or remaining in the
air-chambers. This applies from the time the caissons
touched the bed of the river until they touched the
rock, and the filling up of the air-chambers with
concrete commenced.
But it may be asked — What became of the carbonic
acid in the air-chambers after commencing the filling
up with concrete and closing all means of escape for it ?
To this we will say, that the carbonic acid, no longer
finding its way of escape, instead of accumulating in
the air-chambers, as might be supposed, the said car-
bonic acid which was evolved u^as decomposed or ab-
sorbed by the constant slackening of the hydraulic
lime or hydraulic cement used to make the concrete
for the filling up of the air-chambers.
Before concluding this chapter, we have to say that
there exists a comparative difference as to the effect of
increased atmospheric pressure on the man as a visitor
in the air-chambers and on the man as a laborer, which
difference exists in the following facts :
1. The visitor going into the air-chambers is to re-
main only a short time, and when he goes through
the air-lock he is always accompanied by a competent
person or an officer of the bridge, and every precaution
is taken while remaining in the air-lock, where few
enter at a time, and, according to the pressure, remain
in the air-lock the duration of time we have indicated
as a safe one.
Ill
2. The stay in the air-chambers rarely exceeds half
an hour, very few having remained an hour, and their
visit only occasional, and in some instances, only a soli-
tary one.
3. Any casual visitor, before his or her visit to the
air-chambers, which may be looked on as a pleasure
trip, is always supposed to be in good health ; and no
strangers to the work, visiting the piers, are permitted
to go into the air-chambers without being warned of the
effects of the compressed air, which might, possibly, be
disagreeable to them without being injurious. Tliis
warnmg was sii/fftcient to 'present many from msiting
the air-cJiamhers if they were not in the condition of
health to do it, notioithstanding that they came for that
special purpose. If ever it happened that among the
visitors there were some of irregular habits, their so-
journ of an hour in the air-chambers, without repeating
their visits, and in the meantime taking all the precau-
tions necessary in going in and coming out, insured
them against any further contingency resulting from
their visit.
4. As to the frequent visits made by the officers of
the bridge into the air-chambers, it is superfluous even
to say, that all of them knowing the effects and con-
sequences to which they were exposed, never tried to go
into the air-chambers unless they were in good health,
and as men of regular habits they never exposed them-
selves in any condition which could, in the slightest
degree, predispose them to be affected by the increased
atmospheric pressure existing in the air-lock or in the
air-chambers.
CHAPTER XI.
OPINIONS BASED OJSr FACTS AND OBSEEVATIONS.
As we have already said in Chapter Y, we have very
little to add to the pathological symptoms described and
pathological changes observed during the post mortem
examinations made by other professional gentlemen.
We agree with their correctness ; but as to their causes,
and the conditions in which those changes took place,
we diifer, and will say that we do believe that those
pathological changes were not caused by the immediate
effect of exposure to a condensed atmosphere, but the
result of a reaction produced too suddenly on those
taken sick, by the means used to bring on the reaction ;
among which, we may name such as the adm^inis-
tering of alcoholic stimulants in too large doses for the
nature of the cases, the hot hath administered immedi-
ately after heing taken sicTc, and which was followed in
some cases by immediate paresis, and even paralysis,
from which the patients recovered very slowly, if at all —
a fact which induced us to forbid the use of the hath
entirely in the treatment of such cases. We may also
mention, as a means of bringing on reaction, the inju-
dicious use of magneto- electricity, and the remor>al of
the patients from the piers too soon after they were
talcen sick, and when they were not in a condition to
support such removal.
But, it may be asked, how is it possible that those
pathological changes were observed during the post
mortem examinations, and how to explain or account
for the changes obseroed on the hrain, its membrane,
113
and tJie spinal cord, and not admit that the increased
atmospheric pressure is the immediate cause of these
changes ?
"We will then say, that those pathological changes, if
we examine the time when each patient was taken sick,
and how' long it was before he died, and what was then
the pathological changes observed during the post mor-
tem examinations, it is easily demonstrated that the
pathological changes existing after death, as also the
pathological symptoms observed during life, were not
caused by the compressed air, of wMcTi they would
probably hai^e reco'cered, as did tJie forty-fi'ne others we
reported, but that those pathological changes were
brought on as a sequel of the reaction, interfered with
by increasing that same reaction to a degree which loas
too sudden to be safe, and lessening the chances of the
recovery of those attaclzed.
We think this is applicable to the three cases which
form the subject of the first, second and fifth post mortem
examinations in Chapter Y, where the reaction was fol-
lowed by inflammation of the brain, its membranes, and
also of the spinal cord, which cases hamng run their
regular course of time and terminoMng in death, pre-
sented the same pathological changes that in cerebro
spinal meningetis, whicJi, loith a feio exceptions, termi-
nate fatally, from the fifth to the fifteenth day, and
in which cases the post mortem examination reneal
the same pathological changes as those of which we
have spolien.
As for the third and fourth post 'mortem examinations,
for which we refer our readers to Chapter Y ; they are
a confirmation of the correctness of our views enunciated
in Chapter X, on the influence of too sudden transition
from a temperate atmosphere to a freezing one, as also,
from the too sudden removal from the highly increased
atmospheric pressure into the normal one, (by coming
out of the air-locTi " as rapidly as possible^'') at which
114
time the circulation of the superficial parts of the body
is interfered with, seems to us the cause of the temporary
increased arterial pressure of the blood on the brain and
spinal cord, and, if to this pressure existing on the brain
and spinal cord of any person after coming out of the
air-chambers, and that after reaching the open air that
person is taken sick; if tlien, you still increase hy
hringing on a too sudden reaction hy the use of too
much stimulant, hot hath, electricity or exien remo'oal
from the piers, it may result in a great number of fatal
cases, and the same pathological changes will be ob-
served as in those two cases to which we have referred.
Moreover, we will state, that out of forty-nine cases
we had under our care, forty -five of them, who were kept
at the piers for immediate treatment, when they were
taken sick, not only recovered, but were able to go
home by themselves within twelve hours, and to re-
sume work in a few days. Three of the cases had a
hot hath administered, to thew., and when taken out
were paralysed ; the fourth one, which is case XXXV,
chapter Y, died of sheer exhaustion, as it teas proved
hy the post mortem examination that he had taken no
food during the whole day, hut had heen drinking.
We think we have sufficiently explained the causes of
the pathological symptoms observed during life and
pathological changes after death, and we have now only
to say that, as to the cause of immediate paresis or
paralysis happening on the men shortly after coming
up from working in the air-chambers, and after return-
ing into the open air, they are not the result of infam-
mation of tJte hrain or of the spinal cord, tohich could
not yet have taken place, but exist only as the result
of a too sudden or too strong reaction, succeeding to
a general depression of the system, which is occasioned
hy too long a sojourn in a condensed, atmosphere, and
then paresis or paralysis is but the result of reflex
115
action, caused hy the spontaneous refrigeration of the
whole system, but principally of all the abdominal
organs.
After all the facts and observations we have brought
under the consideration of our readers, we have come
to the conclusion that it is possible to use compressed
air with comparatively few risks of danger to those
working in the air-chambers, and with safety to life,
even if the working men have to be exposed to a pres-
sure of 55 pounds to the square inch, and exclusive
of the 15 pounds of our ambient atmosphere, provided
that the following directions be strictly complied with.
First. — A rigid and close examination as to the fit-
ness of the men who are to be employed in the air-
chambers — an examination which will lessen the risk
for persons unfit to expose themselves to be affected
by the exhaustive power of the compressed air, and
which may cause on their system pathological symp-
toms of which men in fit condition will be exempt.
Second. — Men of middle and low stature and well
built should be preferred; observation has demon-
strated that they resist exhaustion better.
Third. — Single men of good habits should be selected
in preference to any others.
Fourth. — 1^0 man should use tobacco, either smoking
or chewing, while working in the air-chambers.
Fifth. — Only men of temperate habits and regular
diet, consisting of three substantial meals a day, of
which animal food shall form the principal part; and
if using wine, beer, or liquor, to do it very sparingly.
Sixth. — No person having heart disease or aneurism
of large blood vessels, nor any one having any chronic
sore throat, which may have closed the eustachian
canals ; no person having an advanced lung disease ;
and no lung diseases at all after the pressure shall be
over 25 pounds to the square inch.
116
Seventh. — All the men working in the air-cliambers
should, as far as possible, wear their beard and whis-
kers to act as a natural protector against the sudden
change of temperature when coming out of the air-
chambers and remaining in the air-lock.
EigTitli. — Every person working in the air-chambers
ought to wear a flannel undershirt, and a flannel belt
wrapped at least twice around the abdomen, and their
feet should be kept perfectly dry and warm by the
use of tooolen stocMngs and long water-proof hoots.
Ninth. — Any one going into the air-chambers as a
laborer ought to leave ofi" all his superfluous clothing a
few minutes after entering the air-chambers or caissons,
and before commencing work. But when leaving the
air-chambers to return into the normal atmosphere, and
before entering the air-lock, it is an imperative necessity
not only to put on again his clothing, but, if possible,
to add more, such as an overcoat or blanket, which
could be dispensed with immediately after coming out
of the air-lock into the shaft or open atmosphere.
Tenth. — Every workman after coming out of the air-,
chambers should immediately lie down and rest for at
least one hour in a sheltered but well ventilated place,
where the temperature should not be lower than 65^,
and not above 75°, Farenheit.
Blcoenth. — The most important of all, and to which
we have already alluded, but to which we again call
particular attention, is the duration of time to remain in ■
the air-lock when going into the caisson or air-chambers,
which should always be at the rate of one minute foe
EVERY THREE POUNDS OF PRESSURE to the Square incli,
to equalize the pressure in the air-lock with the air-
chambers. And when coming out to return into the
normal atmosphere, the duration of time in the air-lock
to let the compressed air escape and to equalize the
117
pressure with tJie normal atmospJiere sTiould he at the
rate o'e one minute foe every six pounds of pees-
SUEE to the square inch.
Besides the above directions, we believe, from our
repeated observations and experiments, that the time
the men ought to work in the air-chambers should not
exceed, per day, the time indicated below, and which is
in accordance with the amount of pressure to which the
men may be exposed ; and, in our opinion, is necessary
to avoid, as far as possible, all manifestations of patho-
logical symptoms.
DUEATION OF THE TIME OF WOEK PEE DAT FOE THE
LABOEEES IN THE AIE-CHAMBEES OE CAISSONS.
The pressure being from 15 to 20 pounds to the
square inch, two hours' work three times a day, with
two hours' rest between each two hours' work.
From 20 to 25 pounds to the square inch, two hours'
work three times a day, with three hours' rest between
each two hours' work.
From 25 to 30 pounds to the square inch, two hours'
work twice a day, with three hours' rest between each
two hours' work, and one hour's rest at the piers after
the last two hours' work.
From 30 to 35 pounds to the square inch, two hours'
work twice a day, with four hours' rest between each
two hours, and one hour's rest at the piers after the
last two hours' work.
From 35 to 40 pounds to the square inch, one hour's
work three times a day, with two hours' rest between
each hour of work, and one hour's rest at the piers
after the last hour's work.
From 40 to 45 pounds to the square inch, one hour's
work twice a day, with four hours' rest between each
time of work, and one hour's rest at the pier after the
last hour's work.
118
From 45 to 50 pounds to tlie square incli, one hour's
work twice a day, with, six hours' rest between each
time of work, and one hour's rest at the piers after
the last hour's work.
Prom 50 to 55 pounds to the square inch, one hour's
work once a day, and two hours' rest at the piers after
the work.
The rest directed at the piers, after the men had done
worTc for the day, was to ohlige them to rest until they
should ha'oe partially recovered from the exhaustion
caused hy working in the air-chambers, which, not-
withstanding its short duration, if they were not com-
pelled to rest after coming out — principally after the
pressure was over 30 pounds to the square inch — would
gradually, after a few days repeated work, impair
their strength to resist the eflfect of the increased waste
going on on their system while working in the air-
chambers, and which has been mentioned before.
CHAPTEK Xn.
SESTKHSTG OF THE OAISSOIS" FOE THE EAST ABUTMEISTT PIEE
— RESULTS AFFIEMATIVE OF THE SAFETY OF USING
COMPEESSED AIE FOE SIJ^TKESTG- PIEES IIST THE CON-
STEUCTIOIS" OF BEIDOES IN DEEP WATEE, AND FOE
GENEEAL MAEITIME PUEPOSES.
A copy of the first eleven chapters of this small
work were submitted to Mr. J. B. Eads, chief engineer
of the Illinois and Saint Louis Bridge, in the month of
September, 1870. After the perusal of its contents,
desiring to avoid by all possible means the same
pathological symptoms observed on the men who had
been working in the air-chambers of the east and west
caissons, he felt the necessity of having proper attend-
ance given, and prophylactic means employed, for the
men working in the air-chambers when the east abut-
ment caisson should be sunk to a certain depth, and,
if possible, to avoid the recurrence of accidents during
the sinking of this caisson to the rock, and the filling
up of the air-chambers until finished.
The work of sinking the caisson had commenced on
the 15th of ISTovember, 1870, and progressed until the
31st January, 1871, when we were requested to com-
mence our visits at the bridge.
On the 1st February, 1871, we commenced our pro-
fessional visits. The work was progressing in the
following manner :
Some f)ery important improriements had been made
in the construction of the caisson, and which had for
their object not only the comfort, but also the safety,
of those working in it during its sinking.
G
120
The main or central shaft, ten feet in diameter was
carried down into the air-chambers near the bottom,
and there were at the bottom of the shaft two air-locks
eigM feet in diameter hy seven feet six inches in TieigTit
{wTiereas in tTie east pier caisson there was only one),
and each air-locJc of double capacity for the same num-
ber of men who had to go through them to work in the
air-chambers.
" The central shaft was used only for the workmen,
and was provided with a circular stairway; but to
avoid the rather hard labor of walking up, and using
more muscular exertions after leaving the air-cham-
bers, in addition to the stairways, an elevator or lift
to bring the men up was constructed." This not only
contributed to lighten their labor, but ainoided the diffi-
culty of breathing to many of them, as we experienced
in our subsequent visits at the east pier, in ascending
one hundred and seventy {170) steps, and lohich would
be one hundred and ninety {190) in this caisson. It
prevented also further exhaustion of the men after their
repeated exposure in a very condensed atmosphere.
" The method of lighting the air-chambers was also
improved, by burning the candles under an inverted
glass funnel or chimney communicating outside the
air-chambers by pipes, through which the escape of
compressed air was regulated by a valve, thus pro-
ducing above the burning candle a draught which
carried the smoke off."
This improvement in lighting, certainly added to the
comfort and cleanliness of the workmen in the air-cham-
bers, who had a better appearance after coming up to
the surface of the pier.
From the first day of our taking charge of the men
working in the air-chambers, we visited them three times
daily ; the caisson was then fifty-six (56) feet under the
surface of the river, and the pressure in the air-chambers
twenty-seven (27) pounds to the square inch.
131
There were seventy-six (76) men working in the air-
chambers, divided into four gangs, and working two
(2) hours three times a day, with two hour's rest between
each time of work. All of them Tiad worked before in
tJie East and West pier air-chamhers.
During the month of February the number of men
was increased to one hundred and forty (140), The
seventy-six men already at work, after examination^
were found to he able to continue at worTc in the air-
chambers ; but as the pressure increased every day, it
became necessary that each new applicant for work in
the air-chambers be examined carefully as to his fitness
for such work. Besides the seventy-six men already
working, one hundred and thirty-three (133) more men
were examined — of whom sixty-four (64) were found fit
for such work, and sixty-semen {67) were rejected for the
following causes :
25 for general debility, caused by intemperance.
6 for consumption.
3 for epilepsy.
8 for over 45 years' old.
5 for large ulcers of legs.
2 for disease of the heart.
11 having had chills within two weeks.
7 for general debility, caused by exposure or sickness.
The number of men working was 140, which were duly
enrolled, as follows :
11 were from 18 to 20 years' old.
70 " " 20 to 25 " "
38 " " 25 to 35 " "
21 " " 35 to 45 " "
Their nationality was as follows :
39 natives of United States.
12 " England.
56 " Ireland.
26 " Germany.
7 " Canada.
122
Their stature, . with few exceptions, was below me-
dium ; 27 of them were married.
As a generality they were intelligent, and seemed
disposed to follow the physician's directions for their
comfort, health and safety.
A building of convenient size was erected with berths
in it for the men to rest between their time of work.
Another building was also provided for a hospital, con-
taining sixteen (16) beds, in case it should become
necessary.
Each man working in the air-chambers was required
to take his dinner at the pier, and three quarts of a pint
of strong beef tea was provided for each man with his
dinner. No one was allowed to leave the pier from the
commencement of their work in the air-chambers until
one hour after their work was over for the day.
We called the muster-roll every day, and each man
toas examined ty us ; if any were found unfit, from any
cause, to work in the air-chambers, he was prevented
from doing so, and was re-examined twice a day until
we found him fit to return to work.
On the seventh day of February, the pressure in the
air-chambers being thirty-two (32) pounds to the square
inch, the time of work was reduced to two hours twice
a day, with four (4) hours' rest between each time of
work, and one (1) hour's rest at the pier after the last
two hours' work.
On the ninth, the pressure having increased to thirty-
four and a half (34|) pounds, the time of worTc was
again reduced to one (1) hour three (3) times a day^ loith
three (3) houfs rest between each time of work. The
pressure continued to increase every day, and on the
first of March, there being forty-five (45) pounds pres-
sure to the square inch, the time of work was still
further reduced to forty-five (45) minutes., twice a day.,
with six houfs rest between each time of work, and one
hour's rest at the pier after the last forty -five minute's
123
work. The same duration of work was continued until
the completion and filling up of the air-chaml)ers, and
during wMcJi time the pressure was as high as fifty (50)
pounds to the square inch.
From the first day of our attendance at the pier, the
time necessary for the men to remain in the air-locks, to
equalize the pressure, when going into the air-chambers
to work, and when coming of them, was strictly ohserved
according to our directions, hased on the pressure exist-
ing in the air-chamhers at the time : Three pounds of
pressure to the square inch per minute was let into the
air-locks until the pressure was equalized with the air-
chamhers, when going from the normal atmosphere into
the air-chambers, and six pounds of pressure to the
square inch per minute was removed when in the air-
locks, and coming out of the air-chambers to return into
the normal atmosphere.
The regularity of the time necessary to remain in the
air-locks, when going into and coming out of the air-
chambers, was obtained by means of an indicator,
graduated and set hy us every day acccording to the
pressure existing in the air-chamhers.
The regularity of the duration of time which the
workmen remained in the air-locks or intermediate
chambers to equalize the pressure, when going into or
coming out of the air-chambers, certainly prevented
the increase of temperature during their stay in the air-
locks when going into the air-chambers, the tempera-
ture never increasing above eighty-three (83) degrees,
instead of ninety-two (92), as in the air-lock at the
East pier, and the average was seventy-two (72)
instead of eighty (80) degrees ; when coming out from
the air-chambers to return into the normal atmos-
phere it prevented a too great decrease of temperature,
which was never below fifty-six (56) degrees, instead of
thirty-two (32), freezing point, as it had been observed
many times in the air-lock at the East pier.
124
The minimum temperature observed in the air-cham-
bers was fifty-two (52) degrees, and the maximum sixty-
seven (67), but the daily average was sixty (60) degrees
during the progress of the work.
It will be seen that those changes in the condition of
the atmosphere in the air-locks and air-cTiaTribers, and the
daily examination of the men working in them — if some
of the men were affected by the condensed atmosphere,
all but one recovered, and none of those who recovered
were disabled.
One death occurred, but it can be considered as an
exception — and affirmation of the necessity of following
the directions gir)en ty us for insuring safety.
The following twenty-eight (28) observations of cases
are those which happened during the sinking of the
East abutment caisson.
CASE L.— 8th Febettaet, 1871.
Barometer 29° 50'. Thermometer 40°. Weather
cloudy. Pressure 33| pounds.
James Howaed, 34 years ; Ireland ; taken sick after
the second watch he worked, and about twenty minutes
after coming up ; patient of medium stature, well-built.
SYMPTOMS.
Face livid ; pulse 60 per minute ; complains of epigas-
tric pain, and paresis exists in both legs, which, half an
hour afterward, became a plain case of paraplegia.,
The treatment followed was similar to other cases in
Chapter YII, and twelve hours after he was able to go
home without assistance.
CASE LI.— 9th Febkuary, 1871.
Barometer 27° 70'. Thermometer 21°. Weather clear.
Pressure 34| pounds.
Patkiok Killeen, 19 years ; Ireland ; had worked
two weeks; taken sick about twenty-five minutes after
125
coming np. This case was similar to case I. The same
treatment was followed, and, twelve hours after he was
taken sick, he was able to go home.
CASE LH.— llTH Febbuaby, 1871.
Barometer 29° 60'. Thermometer 24. Weather
snowing. Pressure 35| pounds.
YonTAisr Lull, 28 years ; Grermany. This man had
been taken with diarrhoea the day before, but felt well
when he went to work ; was taken sick immediately
after coming up.
SYMPTOMS.
Face livid ; pulse 105 per minute and feeble ; suffered
from paresis of both legs.
The 5<xwe treatment was followed, and in twelve hours
he was able to go home with some assistance.
CASE Lin.— 12th Febeuaby, 1871.
Barometer ^9° JiBJ Thermometer %li^. Weather
cloudy. Pressure S6\ lbs.
James Wilson, 21 years ; Ireland ; had worked two
months ; was taken sick after the second watch, and
twenty -five minutes after coming up ; of medium stat-
ure. This case was similar to case I. The same treat-
ment was followed, and twelve hours after he went
home.
This case, as also cases LI and LII., were brought
on by the men themsel'oes, who, instead of resting imme-
diately after coming up, as we directed, had been run-
ning around, and were consequently taken sick.
On the 20th February, the pressure being forty (40)
pounds to the square inch in the air-chambers, a leak
sprung in the main or central shaft, where tlie elevator
was, and prevented its use to bring up the men after
leaving the air-chambers. During the time the elevator
could not be used, and the men had to walk up one
Gl
126
hundred and seventy (170) steps, turning on a radius
of live feet, the following cases occurred, wMch. still
demonstrate the truth of the theory of exhaustion.
CASE LIV.— 20th Febetjakt, 1871.
Barometer 29° Jf,0'. Thermometer J^J^. WeatJier clear.
Pressure Jf,0 lbs.
James Caset, 28 years ; United States ; had worked
twelve days ; was taken sick half an hour after coming
up. His case was similar to case I, but only more
serious. The same treatment was followed, and twelve
hours after he was convalescent.
CASE LV.— 20th Febbuabt, 1871. Peessuke, 40 Lbs.
H. Donnelly, 24 years ; Ireland ; had worked two
weeks ; was taken sick twenty minutes after coming
up ; case similar to case I ; treatment same, and twelve
hours after was able to go home.
CASE LVI.— 20th Febeuabt, 1871. Peessuke 40 Lbs.
John Kheo, 20 years ; United States ; had worked
ten days ; was taken sick twenty minutes after coming
up ; case similar to case I ; same treatment followed,
and twelve hours after went home well.
CASE LVir.— 21sT Febettaby, 1871. Peessttee 40 Lbs.
Edward Gallagher, 28 years ; Ireland ; had worked
two weeks ; taken sick about half an hour after coming
up ; similar case to the preceding one ; sa^ne treatment,
and twelve hours after was he able to go home well.
On tTie '21st February tJie elevator was again in
running order. No more cases happened until the
24th, when the pressure having increased to forty-two
and a half (42|) pounds — tlie time of work being then
too long for the pressure existing in the air-chambers —
six (6) cases happened in the course of the day, but
this was also caused by the fault of the men who were
taken sick, in consequence of not resting and keeping
quiet as soon as coming up from the air-chambers.^
127
CASE LVin.— 25th Febbttary, 1871. Pbessube 42J Lbs.
Frank Jourdan, 23 years ; United States ; had
worked three months ; was taken sick twenty minutes
after coming up, after the third watch of one hour.
His case was similar to case I. Same treatment^ and
twelve hours after he was able to go home.
As we have said in chapter YII, the 'barometrical and
tTiermometrical changes Tiamng no marked influence
on the production of cases, we think it unnecessary
to continue to record them.
CASE LIX.— 25th Pebbuaet, 1871. Pbessube 42J Lbs.
William O'Eeien", 37 years ; Ireland ; had worked
nine days ; was taken sick fifteen minutes after coming
up, after the third watch of one hour ; same as case
I; same, treatment, and twelve hours after was able to
go home.
CASE LX.— 25th Febbuabt, 1871. Peesstjee 42f Lbs.
F. BuEL, 20 years ; United States ; had worked three
months ; was taken sick twenty minutes after coming
up, and after the third watch of one hour ; case similar
to case 1 ; same treatment, and went home well.
CASE LXL— 25th Febbuabt, 1871. Pbessube 421 Lbs.
L. BuEL, 23 years ; United States ; had worked two
months ; taken sick, twenty minutes after coming up,
after the third watch of one hour; case same as the
preceding ; same treatment, and twelve hours after was
able to go home.
CASE LXII.— 25th Febkuaet, 1871. Pbessube 42J Lbs.
Jeert Wheelee, 25 years ; Ireland ; had worked
three weeks ; was taken sick twenty minutes after
coming up, after the third watch of one hour ; case
similar to the preceding ; same treatment followed, and
twelve hours after had completely recovered.
128
CASE LXin.— 25th Febeuaet, 1871. Peessuee 42^ Lbs.
Pateick Healey, 20 years ; Ireland ; had worked
three months ; was taken sick fifteen minutes after
coming up, after the third watch of one hour ; case
similar to case I ; same treatment^ and twelve hours
after had completely recovered.
From and after the 26th February, the duration of
time of worh in the air-chambers was reduced to forty -
ji'Ge minutes twice a day, with six hours'' rest between
each time of worTc, and one houfs rest at the pier after .
the last time of worlc. No other case happened until
the 18th March, when, at that time — the elevator being
out of running order — two cases happened as follows :
CASE LXIV.— 18th Maech, 1871 Peessuee 46 Lbs.
H. DowNiE, 24 years ; United States ; had worked
three months ; was taken sick a few minutes after
coming up. This case was similar to case YII — even
more serious. The same treatment was followed, and
twelve hours after, he had completely recovered.
CASE LXV.— 18th Makch, 1871. Peesstjee 46 Lbs.
E. Wagnee, 28 years ; Germany ; had worked three
months ; was taken sick immediately after coming up.
This case was the same as case XXVII, but more serious.
The same treatment was followed, but the patient re-
mained twenty-four hours in the hospital at the pier,
before he was able to go home, and after a few days rest,
he had entirely recovered.
The safety with which the men had been working in
the air-chambers, and the immediate recovery of those
taTcen side, had made the men reckless of danger, and
the twelw following cases were mainly caused by the
non-obserxiance of the directions gioen to them, not to
walk up the stairs, but to be brought up by the elevator
used for that purpose ; secondly, to lie down and rest
immediately after coming up, and thirdly, not to drink
129
any water for at least half an hour after leaving the
air-chambers — directions whicTi were not complied with
hy tTiose taken sick.
Moreover, as a proof of the necessity of complying
with our directions in order to insure safety, we might
say that, notwithstanding we had been paralyzed before,
as related in Chapter III, we went into the air-chambers
of the east abutment caisson during its sinking to the
rock, and we never experienced any inconvenience from
our often repeated visits.
CASE LXVI.— 21sT Makch, 1871. Phessuee 4:6 Lbs.
John Lambert, 26 years ; Germany ; had worked
three months ; was taken sick twenty minutes after
coming up from the second watch. Case similar to case
I; same treatment ; recovered, and twelve hours after
was able to go home. .
CASE LXVn.— 23d Mabch, 1871. Peessuee 46 Lbs.
Gay Bttel, 19 years ; Ireland ; had worked three
months; was taken sick half an hour after coming
up from the second watch. Case similar to preceding
one ; same treatment^ and recovery.
CASE LXVni.— 24:TH Maeoh, 1871. Peessuee 48 Lbs.
John Muerat, 23 years ; Ireland ; (gas-fitter ;) had
worked only four days ; was taken sick twenty minutes
after coming up from the first watch, Tiamng remained
at work two Tiours in the air-chambers^ instead of forty-
five minutes, and by not lying down and resting imme-
diately after coming up. His case was similar to the
preceding ; the treatment the same, and twelve hours
after, had entirely recovered.
CASE LXIX.— 26th Maech, 1871. Peessuee 48 Lbs.
Henry Goodaple, 28 years ; United States ; had
worked three and a half months ; was taken sick twenty
130
minntes after coming np from the second watch. Case
similar to case I ; same treatment^ and in twelve hours
went home well.
CASE LXX.— 3d Apeil, 1871. Peessuee 48 Lbs.
Simon Pieeee, 45 years ; Grermany ; had worked two
months ; was taken sick fifteen minutes from the time
of coming up after the second watch. Case similar to
case I ; same treatment followed, and recovery.
CASE LXXL— 4th Apeil, 1871. Peessuee 47 Lbs.
Mike Gleasoist, 23 years ; Ireland ; had worked three
months and a half ; was taken sick about half an hour
after coming up from the second watch. This case was
similar to the preceding ; same treatment followed, and
twelve hours after he had entirely recovered.
CASE LXXn.— 9th Apeil, 1871. Peessuee 47 Lbs.
Joseph Smith, 43 years ; Ireland ; had worked three
months and a half; was taken sick twenty minutes
from the time of coming up after the second watch. Case
similar to case I ; same treatment, and in twelve hours
had entirely recovered.
CASE LXXni.— 9th Apeil, 1871. Peessuee 47 Lbs.
William Jones; 32 years; England; had worked
two months ; was taken sick about the same time as
case LXXII. Case similar to it ; same treatment, and
recovery.
CASE LXXIV.— 12th Apeil, 1871. Peessuee 47 Lbs.
James Walsh, 22 years ; Ireland ; had worked three
months and a half; was taken sick immediately after
coming up. This case was similar to case I, but more
serious ; same treatment followed, and after twelve hours
had entirely recovered.
131
CASE LXXV— 14th Apbil, 1871. Pbessueb 49 Lbs.
J. A. Hoots, 25 years ; Germany ; had worked three
months and a half. This case is an illustration of the
consequences of the non-observance of the directions
given by us to the men working in the air-chambers,
and of the fatal result.
This man had, for a few days, been drinking beer
rather too freely, principally after his day's work was
over ; the day he was taken sick Tie liad not hrougM Ms
dinner with Mm, and instead of resting at the pier,
after coming up from the air chambers, he went home,
about a quarter of a mile distant, on the Illinois shore,
and, instead of taking the proper time to eat his dinner,
he swallowed his food without mastication, and return-
ing to the bridge, drank some beer, and then went to
work again in the air-chambers, and after coming up,
instead of resting and keeping quiet at the pier, as every
man was required to do, he went home immediately,
where, on arriving, he was taken sick, and commenced
to vomit the contents of the stomach, in which was
found pieces of meat the size of a walnut. Within a few
minutes after, general paralysis supervened, and he was
in so critical a condition as to be unable to be removed
from his boarding house to St. Luke's Hospital for three
days. This patient showed similar symptoms and his
case the same course as XVH, chapter YH, and he died
on the 28th day of April.
CASE LXXVI.— 21sTiAPBiL, 1871." Pbesstjee 49 Lbs.
Hawkests (foreman), 42 years ; United States ;
had worked four months, and was taken sick imme-
diately after coming up, after the last watch, having
walked up the circular stairs, instead of being brought
up by the elevator. This case was similar to case VI.
The same treatment was followed, and twelve hours
after he was able to go home, but felt weak. After
a few days' rest, he was able to resume work.
132
CASE LXXVn.— 26th Apbil, 1871. Pbessube 47 Lbs,
John Sullivan", 35 years ; Ireland ; had worked four
months ; was taken sick half an hour after coming up,
and on reaching home, not far distant, for which he
started from the pier without resting, as directed to
do. I saw him an hour after he was taken sick. The
case was similar to case YI. The same treatment was
followed, and twenty-four hours after he had entirely
recovered.
ITow, if we take a retrospective view of the twenty-
eight (28) cases which had occurred during the sinking
and filling up of the east abutment caisson, it will he
seen that twenty- seven (27) of them recoTiered com-
pletely, and many returned to the same worTc, and
that the only death which occurred was caused by the
fault of the deceased, in not following the directions
ginen hy us to eriery man working in the air-chamters.
We think we may claim to have demonstrated the
correctness of the theory of exhaustion, which is cor-
roborated by the examination of the urine of forty-two
(42) more men working in the air-chambers, to ascer-
tain the quantity of urea existing in it, when the
pressure in the air-chambers had not been less than
forty-five (45) pounds to the square inch for over three
weeks. — This examination was made on the 28th, 29th,
and 30th March, 1871, when the men were in the same
condition as were the thirty-two (32) men referred to
in chapter YII. The following are the results of this
examination :
133
Had worked
in the
Air-chambers.
Spec.
Gra'y.
Chemical
Reaction.
Remarks.
Dennis Deering
Henry Malin
William Rowlett
Joseph Moran
Jolin Schwan
E. Lemons.. . .-
a. Clark
James Tafee
John McDonald
Richard Millett
Richard Colgan
Gam. B. Clancey
Patrick Killeen
Timothy O'Keefe...
Joseph Smiths
John Sullivan
Will Whistlick
John Sanders
James Walsh
Dennis Dayle
J. L. WinkeU
M. Dumphy
James Watkins
J. Wheelan
Simons Pierre
Lewis Buel
Or. Buel
Henry Harvey
Henry Goodaple
C. A. Thompson
R. Decourcy
John Kheo
Edward Wagner. . . .
John Wall
Lewis Gibber
Fred. Meyer
John Walton
John Murphy
Patrick McCarty
John Sanderson . . . .
John A. Hoots
■ Wiakelmeyer.
3 months.
2
2
3
3
3
8
3
3
3
3
3
2
2
3
2
3
2
3
2
2
8
2
2
2
3
3
3
3
8
3
2
2
2
3
3
2
2
8
2
3
1025
1025
1025
1025
1025
1025
1026
1026
1024
1024
1024
1025
1029
1025
1025
1028
1027
1028
1030
1025
1027
1025
1025
1025
1028
1029
1080
1025
1029
1025
1028
1028
1030
1025
1026
1030
1029
1026
1028
1028
1029
1026
Acid.
Neutral.
Acid.
Neutral.
Acid.
Case 51.
Case 78.
Case 74.
Case 70.
Case 61.
Case 60.
Case 57.
Case 65.
Case 65.
There was no albumen in the urine examined, the test of heat and nitric acid
having been used for each one.
Besides the talbular statement albove, the urine of
every man taken sick was examined, and the minimum
of specific gravity was found to de never less than 1028,
but in the majority of cases it ranged from 1030 to 1036.
The urine was, in all cases, obtained after the second
micturition, and about twelve hours after they were
taken sick. The quantity of urine voided was also
always greater than when in good health.
134
N"otwithstanding tlie profuse perspiration of each man
working in the air-chambers, the quantity of urine
secreted hy each man in good Tiealth, far from heing less^
was dboTie tTie aimer age^ and talcing, at random, Jive men
worMng in tTie air-cham'bers, say, num'bers 70, 71, 72,73,
and 74 of the above table, each, man averaged from
twenty-eight {28) to thirty {30) ounces of urine, which
were talien separately between seven d^clocTc, a.m., when
they commenced work, and seven o'' clock, p.m., the time
they were leaving the bridge, making only half of the
quantity of urine secreted for twenty -four hours; and
if, taking into consideration the quantity of urea found
after each examination in the urine, taken at a time
when the urea is always to be found in minimum
quantity ; it inust be then admitted that the quantity of
urea^produced in twenty-four hours far exceeded the
normal quality found in the urine of a healthy laboring
man, when working in the normal atmosphere.
Arriving at the end of our work, we must recapitulate
the facts we have advanced.
First. There exists no specific prophylactic against
the effects of compressed air on man.
Second. The effects of compressed air on man, under
a pressure of twenty (20) pounds to the square inch or
less, increases the energy of the physiological functions
of the whole system, without producing pathological
symptoms and effects. \_This is understood only to
persons in good health.']
Third. After the pressure of the condensed atmosphere
has reached twenty (20) pounds, and is still increasing, it
is only by the strictest compliance with certain rules,
and taking such precautions as those indicated in
Chapter XI, that it is posible to use compressed air as
ambient atmosphere where men can work and avoid
the pathological symptoms and effects, which are the
subjects of this work.
135
Fourth. Compressed air can be used with compara-
twe safety^ ei)en at tJie pressure of fifty -five {55) pounds
to the square incli^ for submarine purposes without any
serious result to those working in the compressed am-
biant atmosphere, and we insist that, notwithstanding
the prejudice isrow existing against its use — this
prejudice must yield before its highly useful agency to
engineering, as a means of sinking piers for the con-
struction of bridges in deep water, as well as for
foundations of light houses, or other works for mari-
time purposes. ,
Notwithstanding, the many imperfections which,
doubtless, this unpretentious work contains, we must
claim as having been actuated in its production by
but one motive, namely — the demonstration of the
truth of facts which we had observed, and we think
may be of some interest to the medical profession
by the results we obtained. — Results, important, as
well as useful, for engineering purposes. We expect
that a perusal of this small work by our professional
brethren at large, will, if not meeting their approval, at
least open the held for further investigations, which, we
hope, will be followed by the same results that we
obtained while attending the men who had been suffer-
ing from the effects of increased atmospheric pressure
after coming up from working in the air-chambers in
the caissons of the piers of the Illinois and St. Louis
Bridge, at St. Louis, State of Missouri, United States
of America.
ERRATA.
Page 8, line 23, of which were, read of which where.
Page 11, line 10, bladder sand rectum read bladder and
rectum.
Page 12, line 36, phenomenas read phenomena.
Page 13, line 5, read uninteresting.
Page 14, line 1, phylosophical, read philosophical.
Page 14, line 7, be effected, read be affected.
Page 14, line 26, sood health read good health.
Page 15, line 20, our breathing read our respiration.
Page 16, line 16, our breathing, read our respiration.
Page 21, line 10, resectively, read respectively.
Page 32, line 16, parepsis read, parapsis.
Page 46, line 28, parepsis read paresis.
Page 51, line 34, he discharged, read was discharged.
Page 52, line 10, parepsis, read parapsis.
Page 54, line 30, each read of each.
Page 101, line 16, anlayzing read analyzing.
Page 112, line 30, its membrane read its membranes.
Page 115, line 34, eustachian canals read eustachian
tubes.
Page 123, line 20, read of indicators attached to the
equalizing valves, said indicators.
Page 134, line 17, quality read quantity.
Page 134, line 33, is posible rea^d is possible.
■^r^
I
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